Funai Kazuhito, Kawase Akikazu, Takanashi Yusuke, Mizuno Kiyomichi, Shiiya Norihiko
First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
J Thorac Dis. 2023 Mar 31;15(3):1482-1485. doi: 10.21037/jtd-22-1103. Epub 2023 Mar 15.
Robot-assisted thoracoscopic surgery (RATS) has been widely used in lung cancer surgery. We previously devised a new port arrangement for RATS for lung cancer, the "Hamamatsu Method", to provide good cranial field of view using the da Vinci Xi surgical system. Our method utilizes four robot ports and one assist port, while our video-assisted thoracoscopic lobectomy technique is performed with four ports. We believe the number of ports in robotic lobectomy should not exceed those in video-assisted thoracoscopic lobectomy to preserve the advantage of minimal invasiveness. Furthermore, patients are generally more sensitive to wound size and number than surgeons assume. Thus, by combining the access and camera ports of the "Hamamatsu Method", we devised the 4-port "Hamamatsu Method KAI", which is equivalent to the conventional 5-port method, while maintaining full functionality of all four robotic arms and the assistant. "Hamamatsu Method KAI" showed comparable safety as the conventional 5- or 6-port method. Our improved 4-port method ensures minimal invasiveness while maintaining the same feasibility as the original method. The novelty of this operative method is the combined camera/assistant/access incision, and this technique is an option for RATS for lung cancer. "KAI" is a Japanese suffix indicating a sequel or successor.
机器人辅助胸腔镜手术（RATS）已广泛应用于肺癌手术。我们之前为肺癌的RATS设计了一种新的切口布局，即“滨松法”，以利用达芬奇Xi手术系统提供良好的头侧视野。我们的方法使用四个机器人切口和一个辅助切口，而我们的电视辅助胸腔镜肺叶切除术技术是通过四个切口进行的。我们认为机器人肺叶切除术中的切口数量不应超过电视辅助胸腔镜肺叶切除术的切口数量，以保持微创的优势。此外，患者通常对伤口大小和数量比外科医生想象的更敏感。因此，通过合并“滨松法”的进镜和摄像切口，我们设计了四切口“滨松法KAI”，其等同于传统的五切口方法，同时保持所有四个机器人手臂和助手的全部功能。“滨松法KAI”显示出与传统的五切口或六切口方法相当的安全性。我们改进的四切口方法在保持与原方法相同可行性的同时确保了微创性。这种手术方法的新颖之处在于摄像/助手/进镜切口的合并，并且这种技术是肺癌RATS的一种选择。“KAI”是一个日语后缀，表示续集或后继者。
