甲状腺に対するロボット支援手術
従来の甲状腺切除術に低侵襲性，整容性を高める目的で内視鏡下甲状腺切除術が開発された。その内視鏡手術の限界を克服する手術支援ロボットの導入は，多自由度鉗子，高解像度３次元画像の提供など更に高度な内視鏡手術を実現するものとなった。da Vinci surgical systemを用いたガスレス腋窩アプローチによるロボット支援下甲状腺切除術は，前胸壁，耳介後，経口などのアプローチに比して側方から甲状腺を展開するため甲状腺全体だけでなく，副甲状腺や反回神経の確認に優れており，頸部リンパ節郭清をも安全に行うことが可能となる。また，送気法と異なり空気と血液の陰圧吸引が常時可能となるため安定した術野の維持が...
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| Published in | 日本内分泌・甲状腺外科学会雑誌 Vol. 37; no. 1; pp. 7 - 11 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本内分泌外科学会・日本甲状腺外科学会
2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2186-9545 |
| DOI | 10.11226/jaesjsts.37.1_7 |
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| Abstract | 従来の甲状腺切除術に低侵襲性，整容性を高める目的で内視鏡下甲状腺切除術が開発された。その内視鏡手術の限界を克服する手術支援ロボットの導入は，多自由度鉗子，高解像度３次元画像の提供など更に高度な内視鏡手術を実現するものとなった。da Vinci surgical systemを用いたガスレス腋窩アプローチによるロボット支援下甲状腺切除術は，前胸壁，耳介後，経口などのアプローチに比して側方から甲状腺を展開するため甲状腺全体だけでなく，副甲状腺や反回神経の確認に優れており，頸部リンパ節郭清をも安全に行うことが可能となる。また，送気法と異なり空気と血液の陰圧吸引が常時可能となるため安定した術野の維持が可能となる。国内では保険収載されていないことが最大の問題と言えるが，ロボット支援下甲状腺切除術は更に緻密かつ安全な次世代の甲状腺手術となり得ると考える。 |
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| AbstractList | 従来の甲状腺切除術に低侵襲性，整容性を高める目的で内視鏡下甲状腺切除術が開発された。その内視鏡手術の限界を克服する手術支援ロボットの導入は，多自由度鉗子，高解像度３次元画像の提供など更に高度な内視鏡手術を実現するものとなった。da Vinci surgical systemを用いたガスレス腋窩アプローチによるロボット支援下甲状腺切除術は，前胸壁，耳介後，経口などのアプローチに比して側方から甲状腺を展開するため甲状腺全体だけでなく，副甲状腺や反回神経の確認に優れており，頸部リンパ節郭清をも安全に行うことが可能となる。また，送気法と異なり空気と血液の陰圧吸引が常時可能となるため安定した術野の維持が可能となる。国内では保険収載されていないことが最大の問題と言えるが，ロボット支援下甲状腺切除術は更に緻密かつ安全な次世代の甲状腺手術となり得ると考える。 |
| Author | 石川, 紀彦 |
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| Copyright | 2020 日本内分泌外科学会・日本甲状腺外科学会 |
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| References | 27. Lee J, Kwon IS, Bae EH, et al.: Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab 98: 2701-8270, 2013 12. Liu P, Zhang Y, Qi X, et al.: Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon. J Cancer 10: 3851-3859, 2019 3. Shimizu K, Akira S, Jasmi AY, et al.: Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188: 697-703, 1999 6. Miccoli P, Berti P, Raffaelli M, et al.: Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery 130: 1039-1043, 2001 5. Yamashita H, Watanabe S, Koike E, et al.: Video-assisted thyroid lobectomy through a small wound in the submandibular area. Am J Surg 183: 286-289, 2002 10. Miccoli P, Bellantone R, Mourad M, et al.: Minimally invasive video-assisted thyroidectomy: multiinstitutional experience. World J Surg 26: 972-975, 2002 25. Perrier ND: Why I have abandoned robot-assisted transaxillary thyroid surgery. Surgery 152: 1025-1026, 2012 21. Park JH, Lee J, Hakim NA, et al.: Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery. Head Neck 37: 1705-1711, 2015 28. Lee J, Chung WY: Robotic thyroidectomy and neck dissection: past, present, and future. Cancer J 19: 151-61, 2013 17. Lee J, Kang SW, Jung JJ, et al.: Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations. Ann Surg Oncol 18: 2538-2547, 2011 7. Ishii S, Ohgami M, Arisawa Y, et al.: Endoscopic thyroidectomy with anterior chest wall approach. Surg Endosc 12: 611, 1998 24. Yoo H, Chae BJ, Park HS, et al.: Comparison of surgical outcomes between endoscopic and robotic thyroidectomy. J Surg Oncol 105: 705-708, 2012 18. Kang SW, Jeong JJ, Yun JS, et al.: Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23: 2399-2406, 2009 11. Sephton BM: Extracervical Approaches to Thyroid Surgery: Evolution and Review. Minim Invasive Surg 20:eCollection, 2019 13. Kim MJ, Nam KH, Lee SG, et al.: Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies. World J Surg 42: 393-401, 2018 22. Yi O, Yoon JH, Lee YM, et al.: Technical and Oncologic Safety of Robotic Thyroid Surgery. Ann Surg Oncol 20: 1927-1933, 2013 9. Dobrinja C, Trevisan G, Makovac P, et al.:Minimally invasive video-assisted thyroidectomy compared with conventional thyroidectomy in a general surgery department. Surg Endosc 23: 2263-2267, 2009 19. Ishikawa N, Kawaguchi M, Moriyama H, et al.: First robot-assisted thyroidectomy in Japan performed using a standard da Vinci surgical system. Artif Organs 36: 496-498, 2012 1. Miccoli P, Berti P, Conte M, et al.: Minimally invasive surgery for thyroid small nodules: preliminary report. J Endocrinol Invest 22: 849-851, 1999 14. Chang YW, Lee HY, Ji WB, et al.: Detailed comparison of robotic and endoscopic transaxillary thyroidectomy. Asian J Surg 43: 234-239, 2020 4. Ikeda Y, Takami H, Sasaki Y, et al.: Endoscopic neck surgery by axillary approach. J Am Coll Surg 191: 336-340, 2000 8. Lombardi CP, Raffaelli M, Princi P, et al.: Safety of video-assisted thyroidectomy versus conventional surgery. Head Neck 27: 58-64, 2005 29. Ishikawa N, Kawaguchi M, Moriyama H, et al.: Robot-assisted thyroidectomy with novel camera-port retractor. Innovations 8: 384-388, 2013 26. Lee SG, Lee J, Kim MJ, et al.: Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study. Surg Endosc 30: 3474-3479, 2016 16. Anuwong A, Sasanakietkul T, Jitpratoom P, et al.: Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 32: 456-465, 2018 15. Terris DJ, Singer MC, Seybt MW: Robotic facelift thyroidectomy: patient selection and technical considerations. Surg Laparosc Endosc Percutan Tech 21: 237-242, 2011 20. Lee J, Yun JH, Nam KH, et al.: Perioperative clinical outcomes after robotic thyroidectomy. Surg Endosc 25: 906-912, 2011 23. Lee J, Nah KY, Kim RM, et al.: Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24: 3186-3194, 2010 2. Shimizu K, Akira S, Tanaka S: Video-assisted neck surgery: endoscopic resection of benign thyroid tumor aiming at scarless surgery on the neck. J Surg Oncol 69: 178-180, 1998 |
| References_xml | – reference: 1. Miccoli P, Berti P, Conte M, et al.: Minimally invasive surgery for thyroid small nodules: preliminary report. J Endocrinol Invest 22: 849-851, 1999 – reference: 10. Miccoli P, Bellantone R, Mourad M, et al.: Minimally invasive video-assisted thyroidectomy: multiinstitutional experience. World J Surg 26: 972-975, 2002 – reference: 22. Yi O, Yoon JH, Lee YM, et al.: Technical and Oncologic Safety of Robotic Thyroid Surgery. Ann Surg Oncol 20: 1927-1933, 2013 – reference: 21. Park JH, Lee J, Hakim NA, et al.: Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery. Head Neck 37: 1705-1711, 2015 – reference: 24. Yoo H, Chae BJ, Park HS, et al.: Comparison of surgical outcomes between endoscopic and robotic thyroidectomy. J Surg Oncol 105: 705-708, 2012 – reference: 25. Perrier ND: Why I have abandoned robot-assisted transaxillary thyroid surgery. Surgery 152: 1025-1026, 2012 – reference: 18. Kang SW, Jeong JJ, Yun JS, et al.: Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23: 2399-2406, 2009 – reference: 15. Terris DJ, Singer MC, Seybt MW: Robotic facelift thyroidectomy: patient selection and technical considerations. Surg Laparosc Endosc Percutan Tech 21: 237-242, 2011 – reference: 8. Lombardi CP, Raffaelli M, Princi P, et al.: Safety of video-assisted thyroidectomy versus conventional surgery. Head Neck 27: 58-64, 2005 – reference: 28. Lee J, Chung WY: Robotic thyroidectomy and neck dissection: past, present, and future. Cancer J 19: 151-61, 2013 – reference: 2. Shimizu K, Akira S, Tanaka S: Video-assisted neck surgery: endoscopic resection of benign thyroid tumor aiming at scarless surgery on the neck. J Surg Oncol 69: 178-180, 1998 – reference: 12. Liu P, Zhang Y, Qi X, et al.: Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon. J Cancer 10: 3851-3859, 2019 – reference: 9. Dobrinja C, Trevisan G, Makovac P, et al.:Minimally invasive video-assisted thyroidectomy compared with conventional thyroidectomy in a general surgery department. Surg Endosc 23: 2263-2267, 2009 – reference: 14. Chang YW, Lee HY, Ji WB, et al.: Detailed comparison of robotic and endoscopic transaxillary thyroidectomy. Asian J Surg 43: 234-239, 2020 – reference: 4. Ikeda Y, Takami H, Sasaki Y, et al.: Endoscopic neck surgery by axillary approach. J Am Coll Surg 191: 336-340, 2000 – reference: 3. Shimizu K, Akira S, Jasmi AY, et al.: Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188: 697-703, 1999 – reference: 26. Lee SG, Lee J, Kim MJ, et al.: Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study. Surg Endosc 30: 3474-3479, 2016 – reference: 29. Ishikawa N, Kawaguchi M, Moriyama H, et al.: Robot-assisted thyroidectomy with novel camera-port retractor. Innovations 8: 384-388, 2013 – reference: 7. Ishii S, Ohgami M, Arisawa Y, et al.: Endoscopic thyroidectomy with anterior chest wall approach. Surg Endosc 12: 611, 1998 – reference: 5. Yamashita H, Watanabe S, Koike E, et al.: Video-assisted thyroid lobectomy through a small wound in the submandibular area. Am J Surg 183: 286-289, 2002 – reference: 23. Lee J, Nah KY, Kim RM, et al.: Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24: 3186-3194, 2010 – reference: 6. Miccoli P, Berti P, Raffaelli M, et al.: Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery 130: 1039-1043, 2001 – reference: 16. Anuwong A, Sasanakietkul T, Jitpratoom P, et al.: Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 32: 456-465, 2018 – reference: 13. Kim MJ, Nam KH, Lee SG, et al.: Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies. World J Surg 42: 393-401, 2018 – reference: 17. Lee J, Kang SW, Jung JJ, et al.: Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations. Ann Surg Oncol 18: 2538-2547, 2011 – reference: 27. Lee J, Kwon IS, Bae EH, et al.: Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab 98: 2701-8270, 2013 – reference: 20. Lee J, Yun JH, Nam KH, et al.: Perioperative clinical outcomes after robotic thyroidectomy. Surg Endosc 25: 906-912, 2011 – reference: 11. Sephton BM: Extracervical Approaches to Thyroid Surgery: Evolution and Review. Minim Invasive Surg 20:eCollection, 2019 – reference: 19. Ishikawa N, Kawaguchi M, Moriyama H, et al.: First robot-assisted thyroidectomy in Japan performed using a standard da Vinci surgical system. Artif Organs 36: 496-498, 2012 |
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| Snippet | 従来の甲状腺切除術に低侵襲性，整容性を高める目的で内視鏡下甲状腺切除術が開発された。その内視鏡手術の限界を克服する手術支援ロボットの導入は，多自由度鉗子，高解像度３次元画像の提供など更に高度な内視鏡手術を実現するものとなった。da Vinci surgical... |
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| SubjectTerms | ガスレス腋窩アプローチ ダビンチサージカルシステム ロボット 内視鏡 甲状腺切除術 |
| Title | 甲状腺に対するロボット支援手術 |
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