低侵襲化に向かう心臓手術の潮流―ロボット支援下心臓手術の現在地

The Trend of Minimally Invasive Cardiac Surgery：Where Robot-assisted Cardiac Surgery in Japan is Now

外科治療は臓器・分野によらず低侵襲化の流れであり，心臓手術も例にもれず，その潮流は低侵襲化に向かっている．低侵襲心臓手術（minimally invasive cardiac surgery：MICS）はもはや特別な手術をさす用語ではなくなり，多種多様な心疾患に適応されている一手術方法として認識されるようになった．MICSの普及には，種々の器械・道具の開発，人工心肺装置の発展，診断モダリティの性能向上，そして経験の蓄積が大きく寄与し，現在の低侵襲化時代にいたる．

The trend in cardiac surgery is moving toward minimally invasive procedures worldwide. In Japan, robot-assisted cardiac surgery has started simultaneously with the insurance coverage of minimally invasive cardiac surgery in April 2018. Technology innovations such as the miniaturization of the robot arm, the development of various type of instruments have improved operability and has contributed to the spread of robot-assisted cardiac surgery. On the other hand, there are several issues that may be barriers to its widespread use. The number of facilities for robot-assisted cardiac surgery has not increased as expected probably due to the current insurance system, that is still being developed, the requirement for implementation, and the cost. The current status and issues of robot-assisted cardiac surgery in Japan will be discussed.