シングルポート手術支援ロボットを用いた呼吸器外科手術の麻酔方法に関する検討

Intraoperative Anesthesia Experience in Thoracic Surgery Using a Single-port Surgical Robot System

要旨

　ロボット支援下胸腔鏡手術（robotic-assisted thoracic surgery：RATS）は低侵襲手術として普及が進み，単一ポートのda Vinci SP^®システム（Intuitive Surgical社）が呼吸器外科領域で近年導入された。当院でシングルポートRATSを16症例実施し，術中および術後の麻酔管理を検討した。手術操作や二酸化炭素送気による麻酔管理への大きな影響は見られなかったが，従来のRATSに比較すると術後の疼痛が強い症例を経験した。術後鎮痛管理の再考が求められる。

　The application of robotic-assisted thoracoscopic surgery（RATS）has become increasingly common as a minimally invasive procedure. The da Vinci SP^® RATS system was recently introduced at our hospital for single-port thoracic surgery. The surgical method used with this system is different from that performed with the traditional da Vinci system, involving fewer and smaller incisions although the incision is located below the diaphragm. We have used this single-port RATS for 16 patients’ surgeries, and we reviewed the cases’ intraoperative and postoperative anesthesia management, including analgesic methods. Our review identified no influence of CO₂ insufflation on the patients’ hemodynamic status, although several patients complained of severe pain around the drain site（more than we had expected）when they awoke from general anesthesia. Our experience suggests that further consideration is necessary in order to optimize the pain management in similar cases.