Reduced-port RATSの工夫

Ingenuity of Lobectomy in Reduced-port Robot-assisted Thoracic Surgery （RATS）

2018年4月より呼吸器外科領域のロボット支援下手術（RATS）が保険収載され手術症例が増加しており，今後もさらに増加するものと予想される．RATS肺葉切除術の保険点数が胸腔鏡下肺葉切除と同じであるため，コストの面では不利であるが，開胸，胸腔鏡に続く第三のアプローチ方法として注目されている．

In 1991 we devised an operation using the two-window method in which ports are created at only two sites in the thoracic wall. However, in robot-assisted thoracic surgery （RATS）, five ports are considered necessary for most thoracic approaches, which contrasts with the concept of minimal invasiveness. The number of ports in RATS is larger than that in the two-window method. By combining the two ports in front and the assistant port into a single operation hole （window）, reduced-port RATS could be performed with two ports and one-window in 2023. Quick transition to the two-window method for bleeding and mechanical operation problems is possible. In addition, the assistant actively participates in surgery from the control hole （window）, which is advantageous for education. RATS has no sense of touch. Therefore, particular attention should be paid to the detachment and tunneling of blood vessels. The use of an automatic suture induction tube （Tissuetunneler） enables guidance of the automatic suture in the appropriate insertion direction, prevents entrapment of surrounding tissues and avoids damage, and enables visualization. This approach is considered to contribute to improving the safety of RATS.