多自由度内視鏡外科手術鉗子（Radius Surgical System）を用いた内視鏡外科手術

Clinical experiences of the Radius Surgical System for laparoscopic surgery and laparoendoscopic single-site（LESS）surgery

◆要旨：Radius Surgical System（以下，Radius）は，手術ロボットと，従来の腹腔鏡用鉗子との中間に位置し，先端が自在に屈曲するマニュアルマニピュレータである．筆者らはRadiusを胆石症30例，総胆管結石症10例，胃癌69例，食道癌19例，ヘルニア4例などで使用し，2010年2月現在で140症例と世界最多の臨床経験を有している．また，近年注目されている単孔式内視鏡手術6例（総胆管結石症，胃空腸吻合など）にもRadiusを使用した．Radiusは通常鉗子では難易度の高い部位の縫合・結紮やGambee縫合で特に有用であった．Radiusの基本操作と各術式における使用法について詳述した．

BACKGROUND : Radius Surgical System（Radius）is a two-hand-guided manipulator and has a de?ectable and rotatable tip of additional freedom of two-degrees comparing to conventional laparoscopic instruments. There have been few reports regarding clinical experiences of Radius for laparoscopic surgery including Laparoendoscpic Single-site（LESS）surgery. PATIENTS AND METHODS : From August 2008 to February 2010, 140 conventional laparoscopic surgical procedures were performed using Radius in our hospital; 30 cholecystectomies, 10 choledochotomies, 69 reconstruction for gastric cancer, and the other 25 procedures. Six LESS surgeries were also done using Radius: one cholecystectomy, two choledochotomy, one gastro-jejunal anastomosis for gastric bypass, and the other two local resections of the stomach. RESULTS : Radius enabled us to achieve the optimal penetration angle and was useful for both intracorporeal suturing and ligation such as the closure of the opening of the common bile duct and esophago-jejunostomy. Radius also was of value to overcome in-line viewing and hand/instruments collisions, which are common problems in LESS surgery. It also enabled us to perform complex procedures including Gambee's suture even in LESS surgery.

CONCLUSIONS : This is the largest clinical series of Radius presented to date. Radius facilitated advanced laparoscopic surgery and may have advantages in LESS surgery.