低侵襲心臓手術からロボット支援下心臓手術への移行とその違い

Differences between Minimary Invasive Cardiac Surgery and Robot-assisted Cardiac Surgery in Mitral Valve Repair

テクノロジーの発展は人類にさまざまな恩恵をもたらし，医療現場でも外科系他科において大きく開腹・開胸することは減少し，鏡視下手術は標準手段となった．心臓外科領域では鏡視下手術の割合は低く，胸骨正中切開がいまだ標準である．しかし，20年ほど前より弁膜症において胸骨を切らない低侵襲小切開手術，いわゆる低侵襲心臓手術（MICS）が導入され1，2），さらには直視下で行われてきた心臓手術において一部のパイオニアによってカメラ映像のみで手術を行う，いわゆる完全胸腔鏡下手術（eMICS）が行われるようになり3），パラダイムシフトに等しい発展をもたらした．一方，1998年にロボット支援下僧帽弁形成術（RoMVP）の報告4）後，2000年ころより増加し5），改良発達を伴って徐々に普及している．

It has been more than 10 years since the introduction of small-incision surgery for cardiac valvular disease. The so-called minimally invasive cardiac surgery （MICS） techniques avoid the need for sternotomy, but they are still not considered standard approaches. We started performing MICS at our hospital in October 2010, and we started performing robot-assisted cardiac surgery in June 2019 while undergoing a transition from direct vision to complete endoscopic surgery. We performed a total of 81 cardiac procedures between June 2019 and December 2021；78 of these included mitral valve repair. Because robot-assisted cardiac surgery is an extension of MICS, it is essential to establish safe MICS procedures before introducing robot-assisted cardiac surgery to an institution. We will review and report the results of these procedures at our hospital, including MICS and plastic procedures performed as preparation for the introduction of robot-assisted cardiac surgery. We will also describe changes and ingenuity in robot-assisted cardiac surgery procedures after introduction.