5．低侵襲心臓手術（MICS）における手術機器

Surgical Devices for Minimally Invasive Cardiac Surgery（MICS）

MICSとはminimally invasive cardiac surgeryの略称であり，低侵襲心臓手術を意味する．胸骨を一部あるいは全部温存する心臓手術すべてを含むが，本稿では肋間からアプローチして直視もしくは内視鏡下に行う心臓手術に焦点を当てる．MICSは従来の胸骨正中切開による心臓手術と比較して輸血量，再開胸止血術の頻度，入院期間，術後の回復期間が減少するというメリットが示されている1）．MICSを可能にするためには，術者や手術チーム自身の技術向上が必要であることはいうまでもない．しかし，同等に重要かつ必要不可欠なのが，限られた視野の中で精緻な手術操作を行うための特殊な手術機器である．本稿ではMICSで使用される手術器械を紹介する．

Minimally invasive cardiac surgery（MICS）rapidly has become popular in recent years. To perform meticulous surgical procedures in the limited space, specially designed surgical instruments are very useful. For excellent exposure of the surgical target, thoracoscopic system with high imaging quality such as 4K or 3D HD endoscopy is often used. An articulated rib spreader and/or soft tissue retractor is also useful since those instruments do not interfere with other surgical instruments. A suture catcher is used to pull traction sutures through the chest wall. There are various types of atrial retractor designed for MICS. For fine manipulation in the limited space, long-shafted forceps, needle holders, and scissors are necessary. Those instruments reach deeply located targets and do not interfere surgeon’s and endoscopic view or other instruments. A knot pusher is another essential device to tie knots through a small incision. The automatic tying device is available outside the country. For cardiopulmonary bypass, cannulas designed for peripheral access are used. Most of those cannulas have multiple side holes that work well for excellent perfusion and drainage. There are also specially designed aortic cross-clamps. To make surgeons more comfortable and improve quality of MICS, surgical devices for MICS need to be further innovated.