ロボット支援下僧帽弁形成術を成功させるための工夫

Tips for Successful Robot-assisted Mitral Valve Repair

ロボット支援下弁形成術は胸腔鏡下弁形成術として2018年4月に保険収載され，各施設で導入され，その手術件数が増加することが予測された．しかし，現時点ではいまだに一部の施設でしか施行されていない．求められる施設基準および術者基準のハードルが高いことや，ロボット支援下心臓手術を安定させるためのラーニングカーブが通常の右小開胸下低侵襲心臓手術（MICS）よりも長いためであると推測される．

Robot-assisted valve repair refers to an intervention added to conventional minimally invasive cardiac surgery （MICS）, which is covered by national insurance since April 2018. However, currently, this procedure is performed only at a few hospitals, which is attributable to the need for specialized facilities, as well as surgeon-related criteria including high technical expertise. Notably, the learning curve to stabilize robotic surgery is longer than that for conventional MICS. Our hospital introduced robot-assisted valve repair in June 2018, and we have performed ＞120 surgeries to date. Our policy focuses on “no compromise in the quality of valve repair”. The loop technique is routinely used for valve repair, and the experience gained from median sternotomy and MICS is directly applied to robotic procedures. Robot-assisted surgery enhances surgical field visualization and improves operability even in cases of complex valve repair. In this article, I will describe the procedural innovations, secure establishment of cardiopulmonary bypass, surgical outcomes, and the current challenges in robot-assisted valve repair to achieve safe and improved results.