ロボット支援下心臓手術のstart upと成績安定化のための工夫

Current Situation of Robot-assisted Cardiac Surgery：Start-up and Ingenuity for Stabilizing Results

手術支援ロボットda Vinciサージカルシステムは，遠隔手術用に米軍が1980年代に開発し，その後Intuitive Surgical社（Sunnyvale）に引き継がれた．2000年に胆囊摘出術が米国食品医薬品局（FDA）の認可を受け，2012年には前立腺癌手術の98％がロボット支援下手術で行われた．本邦では2009年に医療機器の使用認可を受け，2018年4月の診療報酬改定でロボット支援下弁形成術（僧帽弁・三尖弁）が保険適用となり，国内の25施設が認定施設としてロボット支援下心臓手術（＝da Vinci手術）を行っている．

In Japan, the medical fee revision in April 2018 allowed insurance coverage for robot-assisted cardiac surgery for mitral and tricuspid valve plasty. We started robot-assisted mitral valve plasty by da Vinci system in June 2019. The artificial chordae reconstruction by the loop method, which has been our basic surgical technique so far, has also been adopted in robot-assisted cardiac surgery. The author has performed three dimensional （3D） endoscopic minimally invasive cardiac surgery （MICS）, but now focuses on robot-assisted cardiac surgery because of the delicate procedure and good operability. The venous drainage cannulation through the femoral vein is done under fluoroscopy. We use a silicon cylinder, that is elastic and provides a wide field of view, to approach to the papillary muscle. Robot-assisted cardiac surgery, which takes a little longer than through a mid-sternum incision, requires some ingenuity to save time. We also mention cadaver training that had to be experienced abroad, such as robot training with a human body donation that will start soon at our hospital.