新しい二孔式RATSのセッティングと実際

Novel Dual-portal Robot-assisted Thoracic Surgery：Setting and Practice

近年の医療機器の進歩，ならびに腫瘍学的なエビデンスの構築により1），胸部外科領域ではより低侵襲な手術としてreduced-port surgery（RPS）が注目され増加傾向である．従来の開胸手術から胸腔鏡補助下手術（video-assisted thoracic surgery：VATS），そして2018年からはロボット支援下手術（robot-assisted thoracic surgery：RATS）が加わり，現在では術式が多様化している．

In recent years, robot-assisted thoracic surgery （RATS） has been attracting attention and trials of reduced-port RATS （RPRATS）, which aims at minimally invasive surgery, instead of conventional multi-port RATS. We have developed dual-portal RATS （DRATS）, which combines robotic precision surgery and minimally invasive surgery. DRATS is performed using a 4 cm main port with wound protector and a second 1.8 cm caudal port. In DRATS, the assistant must have uniportal VATS skills, and it was especially necessary to have the assistant make the surgical field. Therefore, we developed neoDRATS, an RPRATS that allows the surgeon to use the retraction arm and uses all four arms, while maintaining the same wound site （main port ＋ one port） as in DRATS. In this manuscript, we will describe the specific settings, tips, and pitfalls of the DRATS and neoDRATS that we use at our hospital.