2．da Vinci SPによる縦隔腫瘍手術

Robotic Mediastinal Tumor Surgery Using da Vinci Single-port （SP） Surgical System

da Vinci single-port（SP）surgical system（以下，da Vinci SP）［Intuitive Surgical社］は，一つの小さな創からカメラと3本のロボット鉗子を体内に挿入し手術操作を行うシステムである．2023年6月に当科は本機による剣状突起下アプローチ胸線摘出術を開始した．本稿では，da Vinci SPによる縦隔腫瘍手術，特に剣状突起下アプローチ，単孔式胸線摘出術（両側胸膜を切開しての胸腺全摘出，片側胸膜温存，右葉下極のみの摘出）の基本手技とコツを概説し，最後に肋骨弓下アプローチ，単孔式中縦隔腫瘍あるいは後縦隔腫瘍手術についても触れる．ここでお示しする手技とコツは，当科のda Vinci SP手術導入に際し手術見学とカダヴァートレーニングにおいてご指導をいただいたKorea University Guro HospitalのHynn Koo Kim教授の最新の論文1）をもとに，当科での経験を加えたものである．

The da Vinci single-port （SP） surgical system is a new system in which a camera and three robotic forceps are inserted into the body through a single small wound for surgical manipulation. This paper outlines the basic techniques and tips for mediastinal tumor surgery using the da Vinci SP, especially the subxiphoid single-port approach. In addition, we will discuss the subcostal approach single-port middle or posterior mediastinal tumor surgery. The subxiphoid approach with the da Vinci SP requires specific tips and precautions, such as avoiding interference between the camera and forceps, forceps and another forceps, forceps and wound margin, and arm and pubic bone or lower extremity, but it is possible to perform thymectomy with good operability and minimal risk. Thymectomy using the da Vinci SP allows for unilateral pleural preservation and surgery that is almost equivalent to an extended thymectomy. Similarly, middle and posterior mediastinal tumor surgery via the subcostal approach with this system requires specific tips and precautions to avoid chylothorax and diaphragmatic hernia, as well as pain management measures such as modified-thoraco-abdominal nerves through perichondrial approach （m-TAPA） block.