カダバーによるロボット支援下手術トレーニングの現状

Robotic-Assisted Surgery in Plastic Surgery with CST

はじめに

　わが国におけるロボット支援下手術は，2012年に泌尿器科領域の前立腺癌全摘出術が保険適用されたことから始まった 1）。その後，ロボット支援下手術の有用性が認められ，多くの科で続々と保険適用が認められた。形成外科領域においては他領域から大きく遅れをとっていたが，2021年4月に形成外科領域でのロボット支援下手術の保険収載を目標とした日本形成外科学会主導のワーキンググループが設立され，形成外科分野におけるロボット支援下手術を推進する運びとなった。

　新規の手術となるロボット支援下手術においては，カダバーサージカルトレーニング（cadaver surgical training：以下，CST）が非常に有用である。形成外科領域のロボット支援下手術の保険収載に向けた取り組みの1つでもあるロボット支援下CSTについて，有用性および現状の問題点なども併せて紹介する。

　Robotic-assisted surgery in Japan was first covered by insurance in 2012 for total prostatectomy, and since then the usefulness of robot-assisted surgery has been confirmed and insurance coverage has been approved for several types of surgery in Japan. Although plastic surgery has lagged far behind other fields in this regard, research on robot-assisted plastic surgery began at the end of 2019. A working group led by the Japanese Society of Plastic Surgery was established in April 2021 to promote robot-assisted surgery in the field of plastic surgery, with the goal of having it covered by insurance. Robotic-assisted surgery is thus introducing new surgical techniques to the field of plastic surgery. Core surgical training (CST) is extremely useful in the development and mastering of new surgical techniques, as it allows surgeons to learn the anatomy of the surgical field while performing actual surgical procedures. We performed our first robot-assisted CST in October 2021 and have now performed robot-assisted CST in plastic surgeries including those involving a DIEP flap, stemmed rectus abdominis flap, free rectus abdominis flap, vastus lateralis flap, vascular anastomosis, reconstruction with a flexible forearm flap after TORS, and Nuss for funnel chest; our experiences have demonstrated that the use of robot-assisted CRT for all of these techniques is clinically applicable.

　Several issues in plastic surgery need to be resolved, including the acquisition of certificates, but it is important to continue conducting robot-assisted CST because this training is essential for the development of surgery, the selection of surgical techniques, and the mastery of surgical procedures.