da Vinci Xiによる気管支断端被覆手技

Bronchial Stump Coverage Technique by da Vinci Xi

気管支断端瘻は肺葉切除後の0.7～0.9％1，2）とまれではあるが，もっとも厄介な術後合併症の一つである．気管支断端瘻を予防する，あるいは発生後の肺血管への影響を最小限にするという目的で，患者自身の組織を採取し断端に縫合・固定する方法がとられてきた．

da Vinci’s greatest attractions are the fine images acquired with a high-resolution 3-dimensional （3D） endoscope and the precise operation by forceps equipped with an articulated arm. We believed that complicated procedures can benefit from robot-assisted surgery. We have been actively performing collection and sewing of viable tissue using da Vinci Xi for the purpose of preventing bronchial stump fistulas. Of the 44 cases of lobectomy performed by the end of November 2019 using da Vinci Xi, 13 cases underwent bronchial stump covering. The covering procedure was intended for patients with conditions such as diabetes and a history of internal use of steroids. As the dressing, pedicled intercostal muscle was used in 4 cases, and free pericardial fat tissue was used in 9 cases. A good visual field was obtained by appropriately turning the oblique mirror upside down. The smoke emission effect of AirSeal was useful for securing the visual field. The dressing was sutured and fixed using 3-0 or 4-0 Prolene （SH） cut to a length of 10 to 12 cm. The postoperative course was good and bronchial stump fistula did not occur in all cases.