コンソーラーとbedside surgeonが協調して行う単孔式RATS

Consoler and Bedside Surgeon Fused Uniportal Robot-assisted Thoracic Surgery

ロボット支援下手術（robot-assisted thoracic surgery：RATS）はここ数年で本邦でも急速に広がっている．RATSの利点としては，3次元の拡大視野で精緻な操作が行えるため，剝離操作，肺門や縦隔のリンパ節郭清を高い精度で行える点があげられる．また，肺癌に対する薬物療法が大きく進歩する中で進行癌でも威力を発揮し，特に気管支形成術，肺動脈形成術を行う場合においては，卓越した縫合操作を，開胸手術を行うことなく容易に行うことができることは大きな利点である．しかしながら，大部分のRATSを行っている施設ではメーカーが推奨する米国式の5ポートを使用した手術で行っており，従来の胸腔鏡手術よりポート数が増加する．このため，RATSにおいてポート数を減らす試みがなされてきている．

Uniportal thoracoscopic surgery for lung cancer have been rapidly increasing in Japan, and is now recognized as an option for minimal invasive surgery. On the other hand, we have developed a ‘fused robot-assisted thoracic surgery （RATS）’ approach, where the bedside surgeon retracts the lung and staples the pulmonary vasculature and bronchus, and we have performed over 700 cases based on this method. Therefore, combining this fused maneuver with uniportal approach, we introduced consoler and bedside surgeon fused uniportal RATS. Uniportal RATS presents specific challenges, particularly requiring additional hurdles for patients with smaller thoracic cavities, where the limited space can hinder the insertion and angulation of staples. Therefore, when we staples pulmonary vasculature and bronchus, one robotic arm is lifted up from the port and using this space, manual stapler could be easily inserted from the working port. Combining consoler and bedside surgeon fused maneuver with uniportal approach, we would like to standardize our uniportal RATS in the future.