ロボット支援下手術に適した安全な気管支形成術の工夫

Improved Surgical Technique for Safe Bronchoplasty Suitable for Robot-assisted Thoracic Surgery

ロボット支援下手術（RATS）では従来の胸腔鏡補助下手術（VATS）と比較して，三次元拡大視野と操作性に優れ，特に縫合操作を容易に行うことができる．RATSの優れた操作性を生かして，現在でも開胸下に行われることが多い血管形成や気管支形成をRATSで低侵襲に行うことが期待される1～3）．一方でRATSでは触覚がないため，特に糸を締め込む必要がある気管支形成では糸切れのリスクが懸念され，いわゆる「力加減」に関して対策を要する．本稿ではロボットの得手・不得手をふまえ，RATSに適した気管支形成術を検討する．

Robot-assisted thoracic surgery （RATS） is increasingly used in difficult surgeries because of its excellent operability with three-dimensional stereoscopic visual fields and multiple joints. RATS is useful for suture procedures, but not for ligation procedures due to lack of sense of touch, which is needed for precise power adjustment. In this report, we describe bronchoplasty with RATS in a case of right upper lobe resection. A large needle driver and Cadiere forceps were used with the right and left hands, respectively, as instruments for bronchorrhaphy. Barbed suture （V-Loc 180 closure device, 3-0, 15 cm） with a looped thread end was used to minimize the number of ligations for bronchorrhaphy. The 3-0 suture was selected to avoid the risk of cutting a thread. Continuous suture was performed using each of two threads for the semiperimeter of the bronchus clockwise and counterclockwise from the deepest part, and the two threads were ligated where they met. The bronchus was tightened slowly at each stitch, and the last three stitches were made with the bronchus opened. Finally, the threads were carefully pulled to tighten the bronchus. This case indicates that robot-assisted bronchoplasty with continuous suture can be performed safely with no stress.