左側大腸癌腹腔鏡下手術のリンパ節郭清における画像反転の導入

Mirror Image with Up-side-down Monitors for Surgeon and Assistant in Lymphadenectomy of Left Side Advanced Colon Cancer in Laparoscopic Colectomy

　左側進行結腸癌に対する腹腔鏡補助下大腸切除術（LAC）において，下腸間膜動脈周囲リンパ節郭清の際，斜視鏡を用いて術者と助手の画像を反転する．1996年以降の102例のLAC症例のうち，2群以上のリンパ節郭清を行った左側結腸癌66例に対して同手技を行った．手術時間，術中出血量は，左半結腸切除術で200分，118g,S状結腸切除術で177分，176g，低位前方切除術で232分，137gであった．開腹へ移行せざるを得ない出血例は2例，副損傷は1例であった．同手技において，術者と助手のhand-eye coordinationが可能となり，安全かつ迅速に手術を進めることができる．

Mirror image with up-side-down monitors for surgeon and assistant in lymphadenectomy of left side ad-vanced colon cancer in laparoscopic colectomy was introduced in our hospital since 1996. This technique has been used in 66 left side colon cancer cases with over second regional lymphadenectomy. Duration of operation and operative blood loss were 200 minutes, 118g in left hemi-colectomy, 177minutes, 176g in sigmoidectomy, and 232 minutes, 137g in low anterior resection, respectively. Only 2 cases of massive bleeding requiring conver-sion to laparotomy and 1 case of small bowel injury were encountered.