7．マイクロ波を用いた区域間切離

Intersegmental Dissection Using Microwave Energy

近年，原発性肺癌に対する縮小手術の有効性を検証した第3相試験の結果1，2）を受け，区域切除の施行頻度が年々増加している．区域切除における課題の一つは術後気漏であり，JCOG0802試験では，区域切除群で気漏遷延が9.4％，ドレーン再挿入が3.8％と報告されている1）．そのため区域切除特有の手技である区域間切離方法には，さらなる改良の余地があると考えられる．

Lung segmentectomy for small peripheral lung cancers has been increasingly performed in recent years. A critical step in this procedure is the intersegmental plane dissection, which, if not performed properly, may lead to complications such as prolonged air leakage. Traditionally, electrocautery and staplers have been commonly used for this purpose. In this report, we describe our experience using a domestically developed microwave surgical instrument. This device utilizes 2,450 MHz microwave energy to vibrate water molecules within tissue, creating a uniform coagulation layer while keeping tissue temperatures below 100 ℃. This allows for effective sealing of the lung parenchyma. Additionally, its scissor-like shape enables intuitive and precise handling during dissection. Our initial experience demonstrated minimal intraoperative bleeding and a low rate of postoperative complications. These results suggest that the microwave surgical device may offer a safe and effective alternative for lung parenchymal dissection in segmentectomy. Its ability to create a consistent seal without excessive thermal damage may help improve surgical outcomes and reduce postoperative morbidity. This technique could be particularly useful in cases requiring precise anatomical dissection, supporting its broader adoption in thoracic surgery.