3Dモデルを用いたロボット支援下スリーブ肺切除トレーニング法

Robotic-assisted Sleeve Lobectomy Training Using a Three-dimensional Airway Model

気管支スリーブ切除を伴う肺葉切除は，中枢型肺癌に対して肺を温存しつつ根治性を確保できる重要な術式であり，肺全摘と比較して短期・長期予後が良好であることが報告されている1）．一方で，本邦におけるスリーブ肺切除の症例数は過去20年間にわたり年間400～500例程度で推移しており2），呼吸器外科専門医1人あたりに換算すると年間0.3例程度にすぎない．このような症例の希少性が，技術習得の大きな障壁となっている．

In Japan, sleeve lobectomy with bronchial reconstruction accounts for only a small proportion of all lobectomies, making it difficult to acquire sufficient technical proficiency through clinical experience alone. Therefore, structured off the job training is considered important. We have developed a training method for sleeve resection using a high-fidelity, life-sized three-dimensional （3D） airway model reconstructed from computed tomography （CT） data. Recently, robotic-assisted sleeve lobectomy has been increasingly reported. Although robotic systems provide enhanced instrument dexterity, bronchial reconstruction under robotic assistance presents specific challenges, including the lack of tactile feedback, a restricted operative field inherent to minimally invasive surgery, and the need for careful management of suture length, tension, and anastomotic technique. Even experienced surgeons may encounter approach-specific pitfalls, underscoring the importance of adequate preoperative preparation. To address these issues, the 3D model was further refined by incorporating a chest wall module that reproduces the minimally invasive surgical environment, enabling realistic robotic-assisted training. Various continuous suturing techniques, including those using short double-armed needles or absorbable barbed sutures, can be practiced in a dry-laboratory setting. This training system allows repeated practice with easy access, independent of time and location, and may contribute to improved technical skills and procedural safety in robotic-assisted sleeve lobectomy.