腹腔鏡下手術におけるシリコンディスクによる肝圧排法

Liver retraction technique with silicon disc in upper abdominal laparoscopic surgery

◆要旨：上腹部腹腔鏡下手術において術野確保のために肝の圧排は重要である．今回，筆者らはシリコンディスクを用いた方法を考案したので報告する．シリコンディスクとは，シリコンシートで作られた楕円形の臓器圧排器具である．本法は，このディスクを肝臓の下面に敷き込み，T-Bar形状の器具で，これを吊り上げて肝を圧排するというものである．この方法では，肝臓が面で吊り上げられるため組織損傷が少なく，肝の大きさに無関係に圧排が可能である．さらに，シリコンシートによる肝損傷予防効果や肝円索も同時に圧排されるという利点もある．本法の原理はきわめてシンプルであり，習熟にも時間を要さず設置できる有用な方法であると考えるので報告する．

　In upper abdominal laparoscopic surgery, it is important to displace the liver in order to obtain a sufficient operative field. We developed a method for retracting the overlaying left lobe of the liver using a Silicon Disc（Hakko Shoji, Hakko Medical Co,Ltd. Japan）. The Silicon Disc is an elliptical shaped organ retracting device made from a silicon rubber membrane with a flexible ring made from shape memory alloy. The liver is lifted by the Silicon Disc which is inserted beneath the left lobe of the liver and lifted up by a T-shaped instrument made of Kirschner wire which is covered with a Nelaton catheter and a thread. In this method, the liver is lifted up by the silicon membrane so that it cannot suffer physical damage, such as becoming attached to one of the retracting devices during surgery. In addition, this method works regardless of the size of the liver, protects the liver from unexpected contact with foreceps, and also lifts up the falciform ligament. The principle of this method is extremely simple, and we are able to easily establish a good operating field during upper abdominal laparoscopic surgery by using this technique.