腹腔鏡下胃切除手術におけるMiniLapTMを用いた肝挙上法の工夫（Lifting MiniLap法）

Novel method for retraction of the liver using MiniLapTM in laparoscopic gastrectomy

◆要旨：筆者らは腹腔鏡下胃切除手術の術野展開に必要な肝外側区域挙上操作として，MiniLap Alligator Grasper^TM（Stryker社）とポリエステルテープを用いた方法（以下，Lifting MiniLap法と呼ぶ）を工夫した．あらかじめ両端にナイロン糸を結紮させておいたポリエステルテープを，腹腔内に挿入しておき，右心窩部から腹腔内に穿刺挿入したMiniLap^TMの先端で，ポリエステルテープに結紮したナイロン糸と右横隔膜脚を同時に把持する．続いて，ポリエステルテープの対側のナイロン糸を左上腹部で腹腔外に引き出し，創外で把持固定することで肝外側区域を挙上させる．本方法は，ポートが不要かつ極めて簡便で，良好な視野確保が可能であることから，今回短報として報告する．

Liver retraction is a key procedure to obtain good surgical field during laparoscopic gastrectomy regardless of the association of lymph node dissection. A ‘Lifting MiniLap method' is a newly devised technique for safe and protective retraction of the lateral segment of the liver for laparoscopic gastrectomy. At first, approximately 6 cm of soft polyester tape was prepared and was tied with 2-0 monofilament nylon sutures at both ends. One end of the suture was ligated into circle and the other end was connected with straight needle. This tape was placed in the upper abdomen. MiniLap Alligator Grasper^TM was inserted at right epigastrium. The circle of the tape and the esophageal hiatal muscle was simultaneously grasped with MiniLap^TM. The straight needle connected with the nylon suture was pulled out through the abdominal wall, resulting in the appropriate retraction of the liver as needed. Both ends of nylon sutures were then externalized using a MiniLap^TM through the right side of the falciform ligament and the left upper abdomen. This enabled the entire lateral segment of the liver to be retracted efficiently. This method has advantages for it is safe, efficient, and it provides flexibility and good surgical field during the entire laparoscopic procedure without any chance of liver injuries. It is also a simple method that does not require any special techniques, ports or devices for laparoscopic gastrectomy.