ロボット支援下肺区域切除術の導入

Introduction of Robot-assisted Lung Segmentectomy

本邦では，呼吸器外科領域におけるロボット支援下手術は2018年春に保険診療として承認され，さらに2020年春には術式が追加されたことから増加傾向にある．さらに，このほど発表された日本臨床腫瘍研究グループ（JCOG）0802/西日本がん研究機構（WJOG）4607L試験の結果から，今後，小型末梢非小細胞肺癌に対して区域切除術が施行されていくものと考えられる1）．このような現状から，ロボット支援下肺区域切除術が各施設で行われるようになってきている．

Robot-assisted lung segmentectomy will be covered by insurance starting 2020. The results of the Japan Clinical Oncology Group （JCOG） 0802 trial have been reported, and the use of robot-assisted lung segmentectomy is expected to increase in the future. We present an introduction to robot-assisted lung segmentectomy at our institution using actual cases. Our facility constructs vascular three-dimensional （3D） images from computed tomography （CT） images as a preoperative simulation. Robot-assisted surgery is performed with the da Vinci Xi, using four arms with carbon dioxide insufflation through an assist hole in the anterior thoracic region of the fifth intercostal space, with a focus on the eighth intercostal space. The port placement and forceps used are the same as for lobectomy. Interdigitations are identified with intravenous indocyanine green after dissecting the pulmonary arteriovenous veins. After that, the da Vinci Xi firefly is activated, and the non-resected lungs are fluorescently stained to identify the inter-areas, and the inter-areas which are separated with an automatic suture device.