近赤外線分光装置を用いた頸部食道再建における移植空腸の組織酸素飽和度の評価

取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1656号, 学位授与年月日 : 平成16年12月31日, 学位授与大学 : 金沢大

外科手術用ロボット(da Vinci)を用いた新たな胃内手術方法の開発

金沢大学附属病院【はじめに】手術支援ロボット(da Vinci surgical system)は,3次元的な空間の把握が可能であり,従来の腹腔鏡手術の問題点の1つであった手術野の立体的な認識を可能にしている.また,実際に手術を施行するアームが7自由度を有し,様々な方向からの病変へのアプローチが可能である.そのため,外科医が意図する手技をより忠実に再現可能であり,習熟に訓練を要した腹腔内での縫合などの手技が簡便に施行可能である.欧米では様々な術式でロボットを使用した報告が見られるが,腹腔鏡下胃内手術にロボットを使用した報告はない.今回我々は,ブタの臓器を使用した独自の胃内手術モデルを作成し,ロボットを使用した胃内手術の有用性に関して検討を行った.【対象および方法】Turbingen Trainerに食道断端より送気用のチューブを挿入、固定したブタの胃を固定した.十二指腸側断端は縫合閉鎖し、食道より挿入したチューブより室内空気を注入し胃内手術モデルを作成した.このモデルを使用し,腹腔鏡下胃内手術に準じて手術支援ロボット(da Vinci surgical system)を使用し,2例で仮想病変を含めた胃の粘膜切除を行った.また,胃粘膜切除後の欠損部の閉鎖および意図的に作成した胃穿孔の縫合も行った.【結果】施行した2例ともに一括切除が可能であった。摘出胃粘膜の大きさは平均約6cmで、手術時間は約12分間であった。また、胃穿孔部の縫合および胃粘膜切除後の粘膜欠損部の閉鎖ともに特に問題なく簡便に施行可能であった【考察】手術支援ロボットを使用することで,胃内病変の粘膜切除や,穿孔部位の縫合手技が簡便かつ安全に施行可能であることを世界で初めて検証した.研究課題/領域番号:18790957, 研究期間(年度):2006 – 2007出典：「外科手術用ロボット(da Vinci)を用いた新たな胃内手術方法の開発」研究成果報告書　課題番号18790957（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-18790957/)を加工して作

Origami using da Vinci Surgical System

金沢大学大学院医学系研究

Transrectal robotic natural orifice translumenal endoscopic surgery (NOTES) applied to intestinal anastomosis in a porcine intestine model

Background: Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive operation using devices such as flexible endoscopes and linear or circular staplers. Nevertheless, hand-sewn anastomosis in NOTES remains challenging. This study aimed to investigate the feasibility of transrectal robotic NOTES requiring intracorporeal small intestinal anastomosis and closure of the rectal anterior wall incision in a relevant human model. Methods: The authors developed a flexible rectal proctoscope with a diameter of 43 mm for transrectal robotic NOTES. Small intestinal anastomosis was performed in a porcine intestinal transrectal NOTES model using two robotic arms and a camera inserted through the proctoscope and a rectal anterior wall incision. The quality of transrectal small intestinal anastomosis using the da Vinci surgical system (transrectal robotic NOTES group) was compared with that of transabdominal anastomosis using the da Vinci surgical system (transabdominal robot-assisted surgery group) and transrectal anastomosis using traditional transanal endoscopic microsurgery (TEM) instruments (TEM NOTES group). The quality of transrectal rectal anterior wall suturing in the transrectal robotic NOTES group was compared with that of the TEM NOTES group and the open surgical instruments group (open group). Results: Robotic intracorporeal suturing was performed successfully in the porcine intestine model. During small intestinal anastomosis, burst pressure in the transrectal robotic NOTES group (67.7 ± 29.3 mmHg) was similar to that in the transabdominal robot-assisted surgery group (73.3 ± 18.2 mmHg) but significantly higher than in the TEM NOTES group (20.3 ± 24.0 mmHg; p < 0.01). During rectal anterior wall suturing, the burst pressure did not differ significantly between the transrectal robotic NOTES group (149.9 ± 81.1 mmHg) and the open group (195.0 ± 60.5 mmHg). Conclusions: The preliminary safety and efficacy of transrectal robotic NOTES was established. Further studies are required to determine the practical feasibility of this procedure. © 2013 Springer Science+Business Media New York.in Pres

移植腸管微細循環の客観的評価

金沢大学医学部附属病院外科学会抄

Case Report-Gallbladder cyst with an anomalous junction of the cystic duct

Gallbladder cyst is a rare entity. We herein report a case of gallbladder cyst with an anomalous junction of the cystic duct and review the literature. A 49-year-old woman was admitted to our hospital with cholecystolithiasis. Computed tomography (CT) and ultrasonography showed a few stones in the gallbladder. Multi-slice CT cholangiography showed an anomalous junction of the cystic duct which drained into the right hepatic bile duct. At surgery, a smooth mass-like lesion was noted at the fundus of the gallbladder. Laparoscopic cholecystectomy was performed without bile duct injury owing to the preoperative information on the cystic duct. The resected specimen showed a cystic lesion 3.0x2.5 cm in size at the fundus of the gallbladder filled with colorless mucus. Histopathologically, the inner surface of the cyst was lined by a single layer of columnar epithelium without dysplasia