心房細動に対するオフポンプ完全鏡視下手術

Off-pump Totally-endoscopic Surgery for Atrial Fibrillation

本報告では，心房細動に対するオフポンプ完全鏡視下手術について記載する．Ohtsukaら1，2）により提唱されたこの手術は，Wolf-Ohtsuka法やtotally thoracoscopic maze（TT-maze）手術とも呼称される．低侵襲で左心耳処理と外科的アブレーションを行う．傷は5～12 mmのポートの留置に必要な分だけで，患者の回復は早い．手技に慣れてくると90分以下で施行できるようになる．

Off-pump totally-endoscopic surgery for atrial fibrillation is reported. This procedure is also called the Wolf-Ohtsuka procedure or totally thoracoscopic maze （TT-maze） surgery. It is a minimally invasive left atrial appendage management and surgical ablation. The wound is limited to that required for port placement, and the patient recovers quickly. Advantages over WATCHMAN include the that it can be applied regardless of the size of the left atrial appendage, can be performed even if there is a thrombus at the tip of the left atrial appendage, and no wound or device comes on the endocardial side. Advantages over catheter ablation is the potential for embolism prevention by simultaneously performing ablation and the left atrial appendage management. The tips and techniques for this procedure are also described here.