Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Asian J Endosc Surg. 2023 Jan;16(1):147-151. doi: 10.1111/ases.13101. Epub 2022 Jul 3.
Due to its many technical advantages, the scope of robot-assisted thoracic surgery (RATS) is expanding to include extended pulmonary resection. Among such procedures, right bilobectomy is one with a high risk of inducing development of a bronchial stump fistula.
The pericardial fat pad case involved a 71-year-old man with a 31-mm adenocarcinoma in the right lung that had progressed to the intermediate bronchus. During lower bilobectomy, to confirm the tumor margin, an L-shaped stapler was used with stapling only at the oral side, and the bronchus was cut using a scalpel blade grasped with robot forceps. After confirming a negative stump, the pericardial fat was collected at the pedicle and sewn onto the stump. The intercostal muscle (ICM) flap case involved a 61-year-old man with a 16-mm nodule shadow in the lower lobe of his lung and swollen #11i and 7 lymph nodes. Intraoperatively, the #7 lymph node was diagnosed as non-small-cell lung cancer by frozen sections, and lower bilobectomy was performed. The bronchus was divided using a stapler with a green cartridge, and the ICM flap was harvested by changing the direction of the camera to a look-up view and positioning the camera at the 5th intercostal site. His numeric rating score (NRS) at 30 and 90 days post-surgery was 2 and 0, respectively.
Our RATS technique was useful for harvesting the ICM flap. More cases should be accumulated to extend the surgical indication for RATS.
由于其诸多技术优势，机器人辅助胸腔手术（RATS）的应用范围不断扩大，包括扩大性肺切除术。在这些手术中，右肺三叶切除术有较高的支气管残端瘘风险。
心包脂肪垫病例涉及一名 71 岁男性，右肺中叶有一个 31mm 的腺癌已进展至中间支气管。在进行下叶双肺叶切除术时，为了确认肿瘤边缘，使用了 L 形吻合器，仅在口侧进行吻合，然后用机器人抓钳夹住的手术刀切断支气管。在确认残端阴性后，在心包脂肪垫的蒂部采集心包脂肪垫，并将其缝合到残端上。肋间肌（ICM）皮瓣病例涉及一名 61 岁男性，其右下肺有一个 16mm 的结节阴影和肿大的#11i 和 7 号淋巴结。术中，#7 号淋巴结经冷冻切片诊断为非小细胞肺癌，行下叶双肺叶切除术。使用绿色钉匣的吻合器切断支气管，通过改变镜头方向为仰视图并将镜头定位在第 5 肋间隙来采集 ICM 皮瓣。他术后 30 天和 90 天的数字评分（NRS）分别为 2 和 0。
我们的 RATS 技术有助于采集 ICM 皮瓣。应积累更多病例以扩大 RATS 的手术适应证。
