ソロサージャリーで行う単孔式RATSと二孔式RATSの実際

Technical Aspects of Solo Surgery in Uniportal Robot-assisted Thoracic Surgery （RATS） and Dual-portal RATS

近年，reduced-portロボット支援下手術（RATS）が行われるようになってきたが，2021年にはda Vinci Xi（Intuitive Surgical社）を用いた単孔式RATSが報告され1），短期予後も報告されている2）．本稿では単孔式RATSと二孔式RATSについて，当院での手技を中心に解説していく．

Reduced-port robot-assisted thoracic surgery （RATS） has been attempted, leading to the first reporting of uniportal RATS using da Vinci Xi in 2021. This report describes technical aspects of uniportal and dual-portal RATS performed at our hospital. Before initiating uniportal RATS procedure, approval must be obtained from the hospital’s ethical committee if the procedure aligns with hospital policy. In uniportal RATS, 4 cm skin incision is made at 5～7th intercostal space without carbon dioxide （CO2） insufflation. For robotic stapling, the skin incision should be located at 7th intercostal space to accommodate the longer stapler length, and this may pose challenges for patients with shorter statures. Three trocars should be triangularly placed above the surgical wound to avoid collisions between trocars and robotic arms. At our hospital, the surgeon performs lung retraction and site development using fenestrated bipolar forceps without an assistant, relying primarily on Maryland bipolar forceps for dissection. In dual-portal RATS, an additional port located under the rib bow is expected to reduce surgical pain and provide sufficient length for robotic stapling. In conclusion, solo-performed uniportal RATS is technically challenging owing to the special use of forceps, and dual-portal RATS offers greater feasibility.