前縦隔疾患に対する胸腔鏡下手術の工夫と成績―胸骨吊り上げ法

Minimally Invasive Surgery for Mediastinal Diseases in Our Institute：Innovations and Surgical Practice

従来，前縦隔疾患に対する手術は胸骨正中切開，後側方切開，hemi-clamshell，clamshell切開など大きな切開のもとに遂行されていた．1990年代初頭より多くの外科領域で内視鏡下手術が開始され，技術の進歩，低侵襲手術への関心が高まった．呼吸器外科領域でも多くの施設で胸腔鏡下手術が行われている．当科でも1997年より胸腔鏡下縦隔腫瘍切除を開始し，2021年にロボット支援下縦隔腫瘍切除術を開始した．

Since the early 1990s, minimally invasive surgery has been introduced in many surgical fields. The progress of technology and increased interest in minimally invasive surgery has led to innovation from surgery with a large incision to complete thoracoscopic surgery in many facilities. We started thoracoscopic mediastinal surgery in 1997 and robot-assisted mediastinal surgery in 2021. Considering the approach for anterior mediastinal tumor resection, it is necessary to fully understand tumor size, tumor location, and the existence of the tumor invasion to other organs. Especially in the case of tumors located on the cranial side above the innominate vein or thymectomy with dissection of the superior pole of the thymus, ensuring surgical field visibility is essential. In our institute, from the point of cosmetics, surgical field visibility is ensured using carbon dioxide insufflation and a sternum-lifting method. Although the number of cases is limited, we report our ingenuity and actual implementation of the techniques.