腹腔鏡下直腸癌手術における彎曲型腸管クリップの有用性

Utility of the new curved intestinal tract clip in laparoscopic surgery for rectal cancer

◆要旨：腹腔鏡下直腸癌手術において，肛門側腸管の洗浄および無理のない直腸の離断はDST（double stapling technique）が主流の現在，必要不可欠な手技である．筆者らは，彎曲型腸管クリップを発案，制作し，曲線状のカートリッジを持つTri-Stapleによる直腸の切離法を試みている．この方法は操作性に優れ，非常に簡単な方法である．容易となる理由として操作する把持鉗子と腸管の長軸，Stapleのシャフトと腸管長軸が一致する点が挙げられ，かつクランプする鉗子部分およびStapleのカートリッジ部分が軸に対して直角であるため直感的に無理なく操作できる点にあると思われる．考案した彎曲型腸管クリップと曲線状のカートリッジを持つTri-Stapleの組み合わせは，術者の直腸切離吻合操作のストレスを軽減できる方法であると思われる．

In laparoscopic rectal cancer surgery, washing the distal intestinal tract and effortless transection of the rectum are presently essential techniques since DST（double stapling technique） has become the mainstream surgical procedure. We proposed and manufactured a curved intestinal tract clip and are attempting dissection of the rectum by utilizing the shape of a Tri-Staple which has a curved cartridge. This method has excellent operability and is a very easy method. Surgery is made easy because the operated grip forceps and the major axis of the intestinal tract conform to each other and the shaft of the Staple and the major axis of the intestinal tract conform to each other, while the forceps to be clamped and the cartridge of the Staple are right-angled with respect to the axis, thereby allowing surgery to be intuitively and effortlessly carried out. It is believed that the combination of the proposed curved intestinal tract clip and a Tri-Staple which has a curved cartridge are part of a method which enables relieving the stress of the surgeon dissecting and anastomosing the rectum.