ポートからの腹腔鏡視野を想定した3D-CT血管画像が有用であった腹腔鏡下S状結腸・前方切除術を施行した3例

Effectiveness of 3 D-CTA images projecting a laparoscopic visual field from the port during laparoscopic sigmoidectomy, anterior resection : a report of 3 cases

◆要旨：腹腔鏡下大腸切除術は近年急速に普及している．がん対策基本法にも治療の均霑化がうたわれ，近い将来標準術式の一端を担うことが予想される．より安全で確実な手術を施行するために，さまざまな工夫や努力がなされている．当院ではCT装置が新しくなったことを契機に，ポートからの腹腔鏡視野を想定した3D-CT血管画像を，virtual laparoscope法（腹腔鏡モード）として表示し，腹腔鏡下S状結腸・前方切除術の術前シミュレーションおよび術中ナビゲーションに利用した．その結果，血管系の走行・分岐形態の把握が容易となり，実際の手術も安全に施行され，非常に有用であったので報告する．

　Laparoscopic colectomy has been rapidly incorporated into the standard surgical armamentarium. Standardization of therapies has been proposed for Basic Act for Anti-cancer Measures and it is expected that this mode of surgery will be part of standard surgical approaches in the near future. To conduct safer and more sound surgical procedures, various efforts and innovations have been made. On the occasion of replacing the CT facility at our hospital with a newer model, we decided to display a 3 D-CTA image projecting a laparoscopic field from the port on a virtual laparoscopic mode to assist in pre-operative simulation and intra-operative navigation for laparoscopic sigmoidectomy and anterior resection. The image facilitated one to observe the vascular course and the manner of bifurcation of major vessels. By incorporating this finding, the actual surgery was conducted safely ; thus such images were found to be very useful.