食道癌に対する片手補助胸腔鏡下食道切除術

Hand-assisted Thoracoscopic Esophagectomy for Esophageal Cancer

　胸腔鏡下手術を安全に短時間に行うために，腹腔下手術で行われている片手補助の内視鏡下手術を胸腔鏡下手術に応用し食道切除を行ったので報告する．手術手技は片肺換気下の全身麻酔で，左側臥位やや仰臥位ぎみの斜位とし，第7肋間より胸腔鏡を挿入し，上腹部正中切開創より胸骨下を剥離しここより左手を胸腔内に挿入する．聴診三角および胸部第4肋間前腋窩線上に鉗子用のポートを挿入する．胸腔内操作は通常の食道切除と同じ手順で，高周波メスと超音波切離装置にて食道を剥離し，食道切除と縦隔郭清が行えた．この方法は内視鏡下手術に熟練していない術者にも安全に施行できる有用な方法と考える．

We applied Hand-assisted laparoscopic technique, which has been recently reported in the literature, to esophagectomy. Technique All the procedures were performed under general anesthesia with a double lumen endotracheal tube. The patient was placed in a left lateral position. Ipsilateral ventilation was discontinued to collapse the lung. A 12 mm trocar was inserted through the 7th intercostal space in the mid-axillary line for the 10 mm 30-degree rigid thoracoscope. The left hand was inserted into the right thoracic cavity via the retro-sternal space through a mid upper abdominal incision without opening the abdominal cavity.