完全鏡視下低侵襲心臓手術でのアシストポートの有用性

Usefulness of the Assist Port in Totally Endoscopic Minimally Invasive Cardiac Surgery

完全鏡視下低侵襲心臓手術［totally endoscopic minimally invasive cardiac surgery（MICS）］は，モニター視認下に小さな主創から長尺鉗子操作と運針操作を行うため，導入初期は視野確認・手の協調・器具操作のいずれも習熟を要し，明確な学習曲線を伴う手技である1，2）．とりわけ，完全鏡視下僧帽弁形成術や心房中隔欠損症閉鎖術では術者の単独操作に依存しがちで，術者以外が術野へ積極的に関与しにくいことが教育上の課題となる2，3）．これに対し，手順の標準化，チーム編成，3D内視鏡の活用などが導入期の安全な習熟に資すると報告されている2～4）．

At our institution, we have introduced an assist port to support surgeons during totally endoscopic mitral valve repair and atrial septal defect repair. The patient is positioned in a left semi-lateral posture with the right arm elevated. The main working incision is made at the 4th intercostal space near the right anterior axillary line, with additional ports placed for the camera, instruments, aortic clamp, and drainage. A 5-mm assist port is inserted at the 6th intercostal space anterior to the main wound. This port provides countertraction, facilitates field exposure, and functions as a “third hand” for the surgeon or instructor. Because totally endoscopic surgery requires considerable adaptation to limited visualization and maneuverability, the assist port is particularly valuable for beginners and for instructors offering operative guidance.