11．da Vinci SPによる縦隔腫瘍切除

Robotic Mediastinal Tumor Surgery Using da Vinci SP Surgical System

da Vinci single-port（SP）surgical system（以下，da Vinci SP）［Intuitive Surgical社］は，一つの小さな創からカメラと3本のロボット鉗子を体内に挿入し手術操作を行うシステムである．当科は2023年6月に本機による剣状突起下アプローチ胸線摘出術を開始した．

The da Vinci single-port （SP） surgical system is a new system in which a camera and three robotic forceps are inserted into the body through a single small wound for surgical manipulation. This paper outlines the basic techniques and tips for mediastinal tumor surgery using the da Vinci SP, especially the subxiphoid single-port approach. In addition, we will discuss the subcostal approach single-port middle or posterior mediastinal tumor surgery. The basic techniques and tips presented here are based on the latest article by Professor Hynn Koo Kim of Korea University Guro Hospital, who guided us during our surgical observation and cadaver training when we introduced the da Vinci SP surgery, as well as on our experience in our department. The subxiphoid approach with the da Vinci SP requires specific tips and precautions, such as avoiding interference between the camera and forceps, forceps and another forceps, forceps and wound margin, and arm and pubic bone or lower extremity, but it is possible to perform thymectomy with good operability and minimal risk. Similarly, middle and posterior mediastinal tumor surgery via the subcostal approach with this system requires specific tips to avoid chylothorax and diaphragmatic hernia, but can be performed with minimal risk.