動脈瘤周囲の剝離と安全確実なクリップのかけ方は？

How to Clip Cerebral Aneurysms Safely and Reliably?

Point

・安全確実なマイクロサージャリー，クリッピングを行うためには，安定したハサミ操作のもとに無血の術野を目指すことが大切である．

・ふるえのない安定した操作を行うために，体位どり，セッティング，術者の姿勢，ポジションや手を置く位置とそれに基づいたハサミや道具の動きがすべて連動していることを認識する．

・クリッピングはクリップ鉗子と吸引管を両手で連動させ，最後まで先端が視認できるような操作（blading technique）を目指す．

・クリッピングの際は癒着血管の剝離が必要かどうかを判断し，剝離を必要としない安全なデザインをまず考えて，どうしても必要な場合にのみ剝離する．

　For safe and reliable cerebral aneurysm clipping, First of all, clean bloodless surgical field and stable and fine movements of micro scissors are necessary. The surgeon must use both hands and determine the best angle before retracting the brain.

　One of the most basic and important things is that the tips of the clip should be kept continuously in sight until closing clips. We propose a “blading technique” for visualizing the tips of clip blades using a 3-dimensional applier clip manipulation, maintaining contact with the aneurysm while maintaining complementary movement of the suction device in the opposite hand. Before trying to detach the adhering vessels from the aneurysm, the surgeon should consider necessity. Clipping is frequently accomplished using various manipulation techniques with remaining adhesions. This article presents basic clipping and manipulation techniques.