原発性自然気胸に対するマリオネット手技によるreduced port surgery

Evaluation of Reduced Port Surgery for Primary Spontaneous Pneumothorax：Marionette Surgery

自然気胸手術では，単孔式胸腔鏡下手術（以下，単孔式手術）や2孔式胸腔鏡手術（以下，2孔式手術）などのさまざまな報告がある1～5）．われわれは，肺縫合した支持糸を鉗子がわりに操作する手技（通称マリオネット手技）で2 cm以下の創長でreduced port surgery（RPS）を行っている．

Background：We aimed to assess the outcomes of reduced port surgery using “marionette technique” in patients with primary spontaneous pneumothorax （PSP） compared to conventional three-port video-assisted thoracoscopic surgery （VATS）.

Methods：Ninety patients were enrolled in this study from August 2015 to July 2021. The marionette technique was performed as follow. A small single incision less than 2 cm was made at the 5th or 6th intercostal space （ICS） and silicone port was placed. The lesion near the bulla was sutured for traction and the needle was pulled out anchoring suture through the third ICS. The lesion was lifted by traction suture and resected using a mechanical stapler （one-port marionette technique）. If a case of incompletely confirm the surgical margin, additional port was added （two-port marionette technique）. All clinical data were analyzed retrospectively.

Results：Compared with conventional VATS, equivalent results were obtained with marionette technique：operation time （57.0±17.9 vs. 74.9±21.9 minutes）, duration of drainage after operation ［2.4±1.4 vs. 2.9±0.3 days, not siguificant （NS）］, postoperative hospital stay （3.8±2.5 vs. 3.9±2.0 days, NS）, recurrence rate after 2 years （5.3％ vs. 9.4％, NS）, respectively. Post-operative frequency of pneumothorax （FOP） with marionette technique was significantly less than conventional three port VATS （0.032 vs 0.119 time/year）.

Conclusion：Marionette technique for PSP proved to be feasible as a surgical treatment and acceptable outcomes.