ロボット支援下肺切除術における助手介入の定量的評価とソロサージャリーの実現可能性

Quantitative Evaluation of Assistant Intervention in Robotic-assisted Lung Resection and Feasibility of Solo-surgery

ロボット支援下手術（robot-assisted thoracic surgery：RATS）の普及により，助手には従来の開胸手術や胸腔鏡補助下手術（video-assisted thoracic surgery：VATS）とは異なる役割が求められるようになった．当科では2021年5月より5ポートを用いた見上げ式アプローチによるRATSを導入し，2024年6月からは術者が主操作と術野展開を一貫して行う4ポートでのソロサージャリーを開始した．本研究ではRATSにおける助手介入実態を定量的に評価し，ソロサージャリーの実現可能性について検討した．

With the increasing adoption of robot-assisted thoracic surgery （RATS）, the role of surgical assistants has evolved compared to traditional open or video-assisted thoracic surgery （VATS）. At our institution, a 5-port look-up view approach with the da Vinci Xi system has been in use since May 2021, and since June 2024, we have transitioned to a solo-surgery approach in which the primary surgeon independently manages both console operation and surgical field exposure. In this retrospective single-center study, we quantitatively evaluated assistant interventions in 115 cases during the introduction phase and 45 cases during the solo-surgery phase. Assistant interventions such as suctioning and retraction significantly decreased in the solo-surgery phase, while port hopping―a technique allowing instrument switching by the surgeon―was introduced as an alternative. No conversions to thoracotomy or blood transfusions occurred throughout the study period. These findings suggest that, with appropriate strategies and technical adaptations, solo-surgery in RATS is not only feasible but can be performed safely without compromising operative outcomes.