Subcu-retractorおよびvessel dissectorを併用した縦隔鏡下食道抜去術

Video-assisted Transhiatal Esophagectomy:A New Approach Using a Mediastinalscope Combined with Retractor and Vessel Dissector

　近年，食道抜去術に縦隔鏡が導入され，従来の非開胸食道抜去術に比較し，手技の安全性が向上したとの報告が多い．今回われわれは，76歳のハイリスク食道癌患者に対してリトラクターと一体型のスコープ（subcu-retractor）およびvessel dissectorを用いた縦隔鏡下の食道抜去術を施行した．Subcu-retractorは視野確保と視野を明示する上で有用であった．またvessel dissectorは食道と接線方向に走行する神経や深部の血管の剥離操作に際して有用であった．食道抜去術に際し，subcu-retractorおよびvessel dissectorの併用は一層安全な手術を遂行するうえで有力な補助手段となりうるものと思われた．

Recently, video-assisted transhiatal esophagectomy has been reported by several groups. These reports demonstrate that this method is safer than ordinary transhiatal esophagectomy. However, it is difficult to keep good operative view above the level of tracheal bifurcation with this method. In order to improve this disadvantage, we introduced a method using a new type of endoscope combined with a retractor (Subcu -retractor), and a vessel dissector. The video-assisted transhiatal esophagectomy was performed for a 76 year female with esophageal carcinoma.