ロボット支援下肺切除術におけるreduced-port RATSの試み

Reduced-port Robot-assisted Thoracic Surgery for Anatomical Lung Resection

本邦の胸部外科手術の状況をまとめた日本胸部外科学会が発行する“Thoracic and cardiovascular surgeries in Japan during 2021”1）では，ロボット支援下手術（robotic-assisted thoracic surgery：RATS）がはじめて統計上記載され，原発性肺悪性腫瘍手術47,029例に対して4,253例（9.0％）のRATSが行われており，胸腔鏡補助下手術（VATS）34,458例（73.3％）と合わせると，原発性肺悪性腫瘍に対する手術のうち82％超が鏡視下低侵襲アプローチで行われていた．最近ではより多くの症例でRATSが選択される傾向にあり，解剖学的肺切除におけるRATSの割合は今後増加していくことが予想される．

Background：Robot-assisted thoracic surgery （RATS） is typically performed by inserting four robotic arms in addition to one assistant port. Recently, efforts to reduce the number of ports used have been reported.

Subjects：We perform reduced-port RATS using two ports：one 4 cm access port shared by two robotic arms and the assistant, and a second 1.5 cm port primarily used by another robotic arm. We retrospectively reviewed our experience with reduced-port RATS.

Results：We conducted seven cases of reduced-port RATS. These included three right lower lobectomies, and one case each of left lower lobectomy, right upper lobectomy, right S6 segmentectomy, and uniportal RATS left S6 segmentectomy. One case required conversion to an open procedure due to lymph node infiltration into the pulmonary artery, but the planned procedure was completed in the remaining six cases. The average surgery time was 184 minutes （ranging from 140 to 240 minutes）, with blood loss ranging from 1 to 150 ml. Postoperative recovery was smooth in all cases.

Conclusion：Reduced-port RATS is a feasible and safe approach when performed by surgeons with adequate training and experience in uniportal video-assisted thoracic surgery （VATS）.