3．da Vinci SPによる肺葉切除術

Lung Resection by Using da Vinci SP

呼吸器外科手術の発展は大きく二つに分かれており，「精密さ」を追求したロボット手術，「低侵襲」をめざしたreduced port surgeryがそれぞれ進歩してきている．ロボットにおける精密さはその多関節と人間を超える可動域により，狭い胸腔内での剝離や切離を可能にしている．一方でreduced port surgeryは単孔式胸腔鏡補助下手術（uniportal VATS）をはじめ，ロボット支援下手術（RATS）においてもdual port RATS1）やuniporatal RATS2）が報告されるようになり，鉗子などの専用の器械の整備や技術の定型化などもすすんできている．しかしながら鉗子同士の干渉が多いことや手技の熟練度が必要なことが，低侵襲手術においては常に問題となり，それらは「精密な」手術を追求することから遠ざかるようであった．そのような中でda Vinci SP（Intuitive Surgical社）が出現したことは，これらの問題に一石を投じる形になると考える．本稿ではda Vinci SPによる肺葉切除の有用性や安全性について考察したい．

In this paper, we would like to discuss the usefulness and safety of lung resection by using the da Vinci SP. Thirty-seven patients who underwent surgery for lung cancer from February to December 2024 at our hospital were included. The mean age was 70 （28～87） years, 21 were male and 16 were female, with a median operative time of 213 （135～417） minutes and a median console time of 149 （96～254） minutes. The resected lungs were the right upper lobe in 11 cases, the right middle lobe in 3 cases, the right lower lobe in 9 cases, the left upper lobe in 5 cases and the left lower lobe in 10 cases. The conversion to thoracotomy was performed in 2 cases. Postoperative complications included atrial fibrillation, decreased intestinal peristalsis due to vagal neuropathy, and pneumonia, but no complications above Clavien-Dindo classification grade Ⅲ were observed. Although there are very small number of reports, those have shown that thoracic surgery using the da Vinci SP has been performed safely. Lung cancer surgery with the da Vinci SP is still in its infancy, and further expansion of the device and cost reductions are desirable.