INTESTINE Vol.21 No.3(9)


特集名 直腸早期癌─治療の新たな展開
題名 ロボット支援下直腸癌手術
発刊年月 2017年 05月
著者 長澤 芳信 静岡県立静岡がんセンター大腸外科
著者 絹笠 祐介 静岡県立静岡がんセンター大腸外科
【 要旨 】 手術支援ロボットは,従来型腹腔鏡下手術における,①拡大視効果,②術者と助手の視野の共有,③術後の疼痛減少に加えて,④術者がコントロールする手振れのない三次元ハイビジョン画像,⑤人間の手指や手首の動きを模するEndoWrist®インストゥルメント,⑥モーションスケーリング機能・手振れ補正機能を有しており,狭い骨盤腔内での操作が要求される直腸癌手術でとくに有用と考えられる.ロボット支援下直腸切除術は,従来型腹腔鏡下手術と比べて,1.5 倍の費用を要するが,手術時間・出血量・circumferential resection margin・術後合併症率は同程度の報告が多く,技術的・腫瘍学的安全性が報告されている.開腹移行率が少なく,ラーニングカーブが短く,機能温存にも優越性があることが示されつつあることから,有用な術式であると考えられる.
Theme New evolvement in treatment for early rectal cancer
Title Robotic-assisted laparoscopic rectal surgery
Author Yoshinobu Nagasawa Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital
Author Yusuke Kinugasa Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital
[ Summary ] Robotic surgery has been introduced as a new approach worldwide, but primarily in the United States. The da Vinci® Surgical System has been gradually employed for use in many fields in Japan, including gastroenterological surgery. Laparoscopic surgery provides many positive features including magnified views, shared images for operators and other staff members, as well as reduced pain after surgery. In addition to these merits of laproscopic surgery, robotic-assisted laparoscopic rectal surgery provides many other useful benefits, including three dimensional Hi-Vision stable images which are controlled by the operator, EndoWrist® instruments which emulate human wrist and finger, motion scaling and tremor filtration. In robotic-assisted surgery, the conversion rate is lower, and the learning curve is shorter, while voiding and sexual dysfunction complications are less often seen than with conventional laparoscopic surgery. Operating time, estimated blood loss, postoperative complications and circumferential resection margins are not significantly different in robotic-assisted surgery or laparoscopic surgery. Although cost is one and a half times as much as conventional laparoscopic surgery, robotic-assisted surgery is a very useful option for rectal surgery.
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