8．Reduced-port RATSによる肺葉切除

Reduced-port Robotic-assisted Thoracoscopic Surgery for Thoracic Neoplasms via Posterior Approach

ロボット支援下手術［robotic-assisted thoracoscopic（またはthoracic）surgery：RATS］は通常，5ヵ所程度の傷口から行う手術である．肺癌手術において単孔式胸腔鏡補助下手術（VATS）が普及し，そのノウハウを活用することでRATSの傷口を減らすことが可能となっている．

We introduce a novel approach for reduced-port robotic-assisted thoracoscopic surgery for thoracic neoplasms. Surgery is performed via single- or two-incision. Main incision （4 cm） is placed on 8th intercostal space on mid-axillary line and second incision, if needed, is placed on 5th intercostal space on anterior axillary line. The 30 degree oblique scope is inserted via dorsal side of the main incision. Two robotic instruments are inserted vie the remaining space of the main incision or the second incision. Then, the scope is rotated clockwise to obtain posterior view, which is the same view as open thoracotomy. This clockwise rotation makes the lying scope rise up and tilts dorsally. This movement of the scope contribute to improving the performance of patient-side surgeon, as well as extending the movement of the remaining robotic arms, particularly during using the robotic endostapler.