8．エネルギーデバイス・ソフト凝固

Energy Device and Soft Coagulation System in Thoracic Surgery

近年，鏡視下手術の普及に伴い多種多様な手術器具が開発されており，特に1990年代からエネルギーデバイスは著しい進歩を遂げてきた．これらのデバイスは，効率のよい確実な止血と切開を可能にし，手術時間の短縮や出血量の減少に大きく寄与している．一方で，切離時に層構造を破壊するリスクや，膠原線維量の少ない脆弱な肺血管やリンパ管，肺実質など使用対象を選択する際には注意が必要である．

While the recent emergence of energy-based surgical techniques and soft coagulation has made surgical procedures less invasive, the safety and proper use of such advances have yet to be investigated. Herein we review the experimental and clinical use of ultrasonically-activated coagulating shears, a vessel sealing system, incorporating ultrasonic and vessel sealing technology, and a soft coagulation system in thoracic surgery. All energy devices have been reported to be safe for use on pulmonary vessels, and use in combination with a ligature appears to be adequate. The thoracic duct has been reported to be sealed with sufficient pressure using energy devices, which are expected to prevent chylothorax formation. Bipolar scissors can be safely and efficiently applied for dissection of pulmonary vessels without damage to the vessel wall. Monopolar soft coagulation can be applied to shrink bullous changes and stop air leakage or bleeding within the lung.