Mitsuboshi Shota, Maeda Hideyuki, Ogihara Akira, Katagiri Sayaka, Aoshima Hiroe, Matsumoto Takako, Isaka Tamami, Kanzaki Masato
Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Kyobu Geka. 2020 Apr;73(4):270-273.
Since national health insurance began to cover robot-assisted thoracoscopic surgery (RATS) for malignant lung tumors, malignant mediastinal tumors, and benign mediastinal tumors in Japan starting in 2018, the number of RATS performed domestically has increased rapidly. In the case of undiagnosed lung tumor, it is necessary to perform a thoracoscopic lung biopsy in the port arrangement for RATS lung resection in the case of undiagnosed lung tumor. The 2 ports are placed in the same 8th intercostal space and a 3 cm utility thoracotomy is added to the 4th or 5th intercostal space for the thoracoscopic lung biopsy. Because the assistant uses the stapler from the port, the distance to the target area increases. When it is converted to RATS for malignant lung diseases, the utility thoracotomy is often hidden by the robot arm and all ports placed in the 8th intercostal space are far from the target area. Furthermore, the assistant working space outside the patient's body is limited by the robot arms. The Signia stapling system has an adapter to extend the shaft. By attaching the adapter, the shaft can be extended by 10 cm. This permits easy handling of the stapler during both thoracoscopic biopsy and RATS lung resection.
自2018年日本国民健康保险开始覆盖机器人辅助胸腔镜手术（RATS）治疗恶性肺肿瘤、恶性纵隔肿瘤和良性纵隔肿瘤以来，日本国内实施的RATS手术数量迅速增加。对于未确诊的肺肿瘤，在进行RATS肺切除的端口布置中，有必要在未确诊肺肿瘤的情况下进行胸腔镜肺活检。两个端口位于同一第8肋间，在第4或第5肋间增加一个3厘米的辅助开胸用于胸腔镜肺活检。由于助手从端口使用吻合器，到目标区域的距离增加。当转换为治疗恶性肺疾病的RATS时，辅助开胸常常被机器人手臂遮挡，并且所有位于第8肋间的端口都远离目标区域。此外，患者体外助手的工作空间受到机器人手臂的限制。Signia吻合器系统有一个延长杆的适配器。通过连接适配器，杆可以延长10厘米。这使得在胸腔镜活检和RATS肺切除过程中都能轻松操作吻合器。
