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呼吸器外科領域に胸腔鏡下手術が導入され,現在ではほぼ標準的な呼吸器外科医の手技となっている.一方,その胸腔鏡手技を困難とさせる要因の一つに胸腔内の癒着があげられ1),以前は開胸アプローチへ移行することが多かった.しかし,そのような癒着症例に対しても各施設において胸腔鏡下で完遂するための工夫がなされてきている.これまで筆者らは,胸腔鏡下(完全鏡視下)アプローチで開始後,偶発的に胸腔内に全面癒着を認めた症例に対して,胸腔鏡下手術で完遂するための工夫を行ってきたので,そのコツと注意点を提示する.
Purposes:Here, we present the tips and pitfalls of video-assisted thoracoscopic (VATS) total pleural adhesiolysis (TPA), determined on an empirical basis.
Patients and Methods:From 2012 to 2020, VATS-TPA was performed in 33 patients undergoing pulmonary anatomic lung resection at our institute. The basic procedure was as follows:after peeling off the area of pleural adhesion surrounding the surgical ports using the fingers, the thoracoscope was inserted into the thorax and the adhesions in other areas were peeled off under thoracoscopic guidance.
Results:The adhesiolysis group had a longer operating time, greater blood loss, and higher rate of conversion to thoracotomy compared to the non-adhesiolysis group. However, the results were acceptable considering the extra manipulation for adhesiolysis.
Conclusions:VATS-TPA is a necessary component of the standard surgical procedure for general thoracic surgeons in cases of total pleural adhesion.
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