RATSの低侵襲化への取り組みと課題

Efforts and Challenges in Reducing Invasiveness of Robot-assisted Thoracic Surgery

肺悪性腫瘍に対するロボット支援下手術（robot-assisted thoracic surgery：RATS）は，2018年に肺葉切除術が保険収載され，2020年に区域切除術がさらに加わり，急速に普及している．当施設では2018年の保険収載を契機に肺悪性腫瘍に対するRATSを導入し，これまでポート配置の最適な方法を模索しながら試行錯誤を繰り返してきた．

Robot-assisted surgery （RATS） for malignant lung tumors has been rapidly popular, with lobectomy receiving insurance coverage in 2018 and segmentectomy in 2020. A total of 210 patients with malignant lung tumors were treated by RATS from August 2018 to July 2024 in our institute. Initially, we employed the look-up-view approach. However, in 2021, we switched to a four-port, open-thoracotomy-view approach to align the surgical view with that of thoracoscopic surgery using a face-to-face monitor. Since 2023, we have implemented the Dylewski method, which involves port placement within the same intercostal space. The median operation time and console times were 192 minutes and 143 minutes, respectively, with minimal blood loss during surgery. Conversion to video-assisted surgery or thoracotomy was required in four patients （1.9％）. The focus on reduced-port RATS in thoracic surgery is increasing, and we believe it is essential to continue exploring optimal approaches to further minimize invasiveness while maintaining safety and oncological efficacy.