ロボット支援腹腔鏡下胃切除術における腫瘍位置同定法—Firefly®とelastography併用超音波法による精度向上の試み

Da Vinci Firefly and elastography in robot-assisted laparoscopic gastrectomy : A novel, prompt, and reliable tumor localization method

◆要旨：腹腔鏡下胃切除術での腫瘍位置同定法には，術中内視鏡観察法や色素法などが行われているが，正確性や迅速性に課題がある．当科ではロボット支援腹腔鏡下胃切除術での腫瘍位置同定に，da Vinci Firefly^®を用いたindocyanine green（ICG）ナビゲーション下elastography併用術中超音波法（FNE）を用いている．術前の内視鏡下にマーキングクリップを施行し，同時に前壁側粘膜下にICGを局注する．胃切離前にFirefly^®でICGを観察し，大まかなクリップ位置を把握したのち，腹腔鏡用超音波でクリップを同定し，胃切離線を決定する．クリップ同定割合は100％であり，FNEはICG非併用群と比べ，クリップ同定所要時間が有意に短かった．Firefly^®を用いたelastography併用超音波法は腫瘍位置同定所要時間の短縮化と安定化に有用な方法と思われた．

　Although various tumor localization methods for totally laparoscopic gastrectomy have been reported, there are still some issues regarding speed and accuracy. In this study, we developed a novel tumor localization method for robot-assisted laparoscopic gastrectomy using a combination of fluorescence and elastography. Prior to surgery, endoscopic clipping was performed near the tumor site on either the proximal or distal side, and indocyanine green was injected into the gastric submucosa on the anterior wall 1-3 days before the operation. The resection line was determined using elastography combined with ultrasonography after obtaining a rough clip localization picture with fluorescence observation under the Firefly^®. Our results demonstrate that this intraoperative ultrasonography combined with fluorescence navigated ultrasound elastography is a reliable and prompt method for tumor localization.