ロボット支援手術の現状と将来性について

The Current Status and Future of Robot-assisted Thoracic Surgery

2018年4月の診療報酬改定で，肺悪性腫瘍に対する肺葉切除と縦隔腫瘍に対するロボット支援手術が保険収載された．全国的に呼吸器外科ロボット手術を導入する施設も増加して，2019年10月の時点で120施設に及んでおり，今後もさらに増加するものと予想される．ロボット支援肺葉切除術の保険点数が胸腔鏡肺葉切除術と同じであるため，コストの面では不利であるが，開胸，胸腔鏡に続く第3のアプローチとして注目されている．

In the pursuit of minimally invasive surgery, there is no objection to the replacement of conventional open surgery with robotic surgery in highly difficult cases of pulmonary and mediastinal tumors. However, compared to video-assisted thoracoscopic surgery, the benefits of performing robotic surgery in standard lung cancer cases are few. A surgeon with master robotic skills, in addition to excellent 3-dimensional （3D） camera control, can effectively use a retraction arm instead of increasing the number of the port. We think that such a surgeon can have an extremely high success rate. We started performing robotic surgery in September 2018 and have had more than 70 cases since then. We developed a manual to promote patient safety and common understanding between the operator and surgical assistants. In this manuscript, we introduce our current robotic surgery technique for lung cancer. The current status, problems, and the future of robotic thoracic surgery are also described.