1．単孔式ロボット支援下手術

Uniportal Robotic Assisted Pulmonary Resection

近年では低侵襲手術が進歩し，胸腔鏡補助下手術（video-assisted thoracic surgery：VATS）が一般的になり，2024年版肺癌診療ガイドラインでもc-stage1の肺癌に対する手術はVATSが強く推奨された（推奨の強さ1，エビデンスの強さB）1）．一方，VATSの中でもアプローチ方法に関しては各施設でさまざまであるが，そのなかでも単孔式VATS（uniportal video-assited thoracic surgery：UVATS）は1ヵ所の4 cm程度の創部からすべての操作を行う手術方法で，創を最小限にとどめることで患者の術後回復を早めることが報告されている．当科においてもUVATSは疼痛が非常に少なく患者の満足度が高い．日本内視鏡外科学会のガイドライン2）でc-stage1の肺癌に対して，UVATSか肺葉切除を行うことが提案された（弱い推奨，エビデンスの強さC）．当科で2019年に導入して以来の治療成績は良好であった3）．

Background：We introduced the uniportal robotic assisted thoracic surgery （URATS） using da Vinci Xi in 2023 after notification to and approval by the Highly Difficult and New Medical Technology Review Division of the Osaka University Hospital. In our department, URATS is indicated for c-stage 1 lung cancer, metastatic lung tumors, and benign diseases.

Methods：The cross-shaped center guide point is aligned with the dorsal surface of the window. The most dorsal arm is not used, and the camera is placed on the dorsal side. The assistant checks which arm is interfering and adjusts the position and height of the port to find a point where there is no interference. It is also important to select a field of view that allows safe manipulation of the target structure without interference, rather than sticking to one field of view.

Discussion：One of the advantages of the URATS is that it allows for a close view. While this allows for highly accurate surgery, it also has disadvantages in terms of cost and learning curve. We plan to continue to accumulate and validate cases, as this may be a beneficial treatment option for patients.