良性縦隔腫瘍に対する単孔式RATSと肺悪性腫瘍に対する三孔式RATS

Single-port Robot-assisted Thoracic Surgery （RATS） for Benign Mediastinal Tumors and Three-port RATS for Lung Malignancies

呼吸器外科領域におけるロボット支援下手術（robot-assisted thoracic surgery：RATS）が2018年4月に保険適用となって以来，安全な導入を重要視するために日本においては5個あるいは6個の創を作成する方法がとられてきた．近年では低侵襲性を追求する観点から，創数を減ずるreduced-port RATSが注目されつつある．本稿では当院の取り組みを紹介する．

The following shows how we perform reduced-port robot-assisted thoracic surgery （RATS） at our hospital. For benign mediastinal tumors, we perform uniportal RATS. A 4.0 cm wound is made between the anterior and middle axillary lines, between the 5th and 7th intercostal spaces, in the supine position. Three 8 mm ports are placed in the wound, and an oblique telescope, a fenestrated bipolar forceps for the left hand, and a long bipolar forceps for the right hand are inserted from the dorsal side. Three-port RATS is performed for lung malignancies. As an example of left surgery, a 4.0 cm wound is created anteriorly at the 6th intercostal space, and a left-hand fenestrated bipolar forceps is placed forward in the wound. A 12 mm port is placed at the midaxillary line and an 8 mm port at the posterior axillary line of the 8th intercostal space, and a long bipolar forceps for the right hand and Tip-Up forceps for the retraction arm are placed respectively. Although the short-term surgical results are comparable to those of the conventional method, there are still many issues to be addressed, such as assistant movement and wound placement, and there is room for improvement.