IV.ロボット支援下直腸手術の現状と未来

ロボット支援下手術は,多関節を有する手術器具,手ぶれ防止機構やmotion scalingによる精緻な動作によって,従来の腹腔鏡手術での操作困難性などの短所を補うことができ,特に直腸癌手術のような,狭い骨盤腔内で精密な手術操作を行うことに適している.本邦では2009年にintuitive社のda Vinci Surgical Systemが薬事承認,2018年4月からはロボット支援下腹腔鏡下直腸切除・切断術が保険収載され,ロボット支援下直腸手術の件数は増加している.現在のところ開腹手術,腹腔鏡手術に対する優越性に関する強いエビデンスはないが,技術的難易度が高い症例での有用性が示唆されている.現...

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Published in日本大腸肛門病学会雑誌 Vol. 72; no. 10; pp. 567 - 574
Main Authors 松山, 貴俊, 中島, 康晃, 絹笠, 祐介, 徳永, 正則
Format Journal Article
LanguageJapanese
Published 日本大腸肛門病学会 2019
Subjects
Online AccessGet full text
ISSN0047-1801
1882-9619
DOI10.3862/jcoloproctology.72.567

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Abstract ロボット支援下手術は,多関節を有する手術器具,手ぶれ防止機構やmotion scalingによる精緻な動作によって,従来の腹腔鏡手術での操作困難性などの短所を補うことができ,特に直腸癌手術のような,狭い骨盤腔内で精密な手術操作を行うことに適している.本邦では2009年にintuitive社のda Vinci Surgical Systemが薬事承認,2018年4月からはロボット支援下腹腔鏡下直腸切除・切断術が保険収載され,ロボット支援下直腸手術の件数は増加している.現在のところ開腹手術,腹腔鏡手術に対する優越性に関する強いエビデンスはないが,技術的難易度が高い症例での有用性が示唆されている.現在いくつかの企業で,新技術を搭載した新型手術支援ロボットが開発されており,今後手術システムの改良による治療成績の向上や,企業間の競合によるロボットや周辺機器の低価格化が期待される.
AbstractList ロボット支援下手術は,多関節を有する手術器具,手ぶれ防止機構やmotion scalingによる精緻な動作によって,従来の腹腔鏡手術での操作困難性などの短所を補うことができ,特に直腸癌手術のような,狭い骨盤腔内で精密な手術操作を行うことに適している.本邦では2009年にintuitive社のda Vinci Surgical Systemが薬事承認,2018年4月からはロボット支援下腹腔鏡下直腸切除・切断術が保険収載され,ロボット支援下直腸手術の件数は増加している.現在のところ開腹手術,腹腔鏡手術に対する優越性に関する強いエビデンスはないが,技術的難易度が高い症例での有用性が示唆されている.現在いくつかの企業で,新技術を搭載した新型手術支援ロボットが開発されており,今後手術システムの改良による治療成績の向上や,企業間の競合によるロボットや周辺機器の低価格化が期待される.
Author 徳永, 正則
松山, 貴俊
中島, 康晃
絹笠, 祐介
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  fullname: 絹笠, 祐介
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  fullname: 徳永, 正則
  organization: 東京医科歯科大学大学院消化管外科学分野
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References 9) Cui Y, Li C, Xu Z, et al: Robot-assisted versus conventional laparoscopic operation in anus-preserving rectal cancer: a meta-analysis. Ther Clin Risk Manag 13:1247-1257, 2017
25) D'Annibale A, Pernazza G, Monsellato I, et al: Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27:1887-1895, 2013
39) Spinelli A, David G, Gidaro S, et al: First experience in colorectal surgery with a new robotic platform with haptic feedback. Colorectal Dis 20:228-235, 2017
6) Jayne D, Pigazzi A, Marshall H, et al: Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial. JAMA 318:1569-1580, 2017
21) Luca F, Valvo M, Ghezzi TL, et al: Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 257:672-678, 2013
16) Baukloh JK, Reeh M, Spinoglio G, et al: Evaluation of the robotic approach concerning pitfalls in rectal surgery. Eur J Surg Oncol 43:1304-1311, 2017
29) Odermatt M, Ahmed J, Panteleimonitis S, et al: Prior experience in laparoscopic rectal surgery can minimise the learning curve for robotic rectal resections: a cumulative sum analysis. Surg Endosc 31:4067-4076, 2017
36) Yamaguchi T, Kinugasa Y, Shiomi A, et al: Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc 32:4498-4505, 2018
7) Prete FP, Pezzolla A, Prete F, et al: Robotic Versus Laparoscopic Minimally Invasive Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Surg 267:1034-1046, 2017
17) Panteleimonitis S, Pickering O, Abbas H, et al: Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study. Int J Colorectal Dis 33:1079-1086, 2018
19) Shiomi A, Kinugasa Y, Yamaguchi T, et al: Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis 31:1701-1710, 2016
41) Peters BS, Armijo PR, Krause C, et al: Review of emerging surgical robotic technology. Surg Endosc 32:1636-1655, 2018
3) Stevenson AR, Solomon MJ, Lumley JW, et al: Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA 314:1356-1363, 2015
32) Morgan MS, Shakir NA, Garcia-Gil M, et al: Single- versus dual-console robot-assisted radical prostatectomy: impact on intraoperative and postoperative outcomes in a teaching institution. World J Urol 33:781-786, 2015
33) Hottenrott C: Robotic versus laparoscopic surgery for rectal cancer and cost-effectiveness analysis. Surg Endosc 25:3954-3956; author reply 3957-3958, 2011
35) Kim HJ, Choi GS, Park JS, et al: Selective lateral pelvic lymph node dissection: a comparative study of the robotic versus laparoscopic approach. Surg Endosc 32:2466-2473, 2018
40) Lang S, Mattheis S, Hasskamp P, et al: A european multicenter study evaluating the flex robotic system in transoral robotic surgery. Laryngoscope 127:391-395, 2017
4) Weber PA, Merola S, Wasielewski A, et al: Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689-1694; discussion 1695-1696, 2002
8) Li X, Wang T, Yao L, et al: The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: A meta-analysis and systematic review. Medicine (Baltimore) 96:e7585, 2017
24) Kim HJ, Choi GS, Park JS, et al: The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity score-matched analysis with laparoscopic surgery. Colorectal Dis 20:O103-O113, 2018
34) Yamaguchi T, Kinugasa Y, Shiomi A, et al: Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc 30:721-728, 2016
38) Shin US, Nancy You Y, Nguyen AT, et al: Oncologic Outcomes of Extended Robotic Resection for Rectal Cancer. Ann Surg Oncol 23:2249-2257, 2016
15) Gorgun E, Ozben V, Costedio M, et al: Robotic versus conventional laparoscopic rectal cancer surgery in obese patients. Colorectal Dis 18:1063-1071, 2016
11) Xiong B, Ma L, Huang W, et al: Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 19:516-526, 2015
5) Pigazzi A, Ellenhorn JD, Ballantyne GH, et al: Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521-1525, 2006
2) Fleshman J, Branda M, Sargent DJ, et al: Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA 314:1346-1355, 2015
13) Fung A, Trabulsi N, Morris M, et al: Laparoscopic colorectal cancer resections in the obese: a systematic review. Surg Endosc 31:2072-2088, 2017
23) Broholm M, Pommergaard HC, Gogenur I: Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis 17:375-381, 2015
12) Liao G, Li YB, Zhao Z, et al: Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence. Sci Rep 6:26981, 2016
14) Hellan M, Ouellette J, Lagares-Garcia JA, et al: Robotic Rectal Cancer Resection: A Retrospective Multicenter Analysis. Ann Surg Oncol 22:2151-2158, 2015
20) Kim J, Baek SJ, Kang DW, et al: Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching. Dis Colon Rectum 60:266-273, 2017
42) Hagn U, Konietschke R, Tobergte A, et al: DLR MiroSurge: a versatile system for research in endoscopic telesurgery. Int J Comput Assist Radiol Surg 5:183-193, 2010
22) Lee SH, Lim S, Kim JH, et al: Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res 89:190-201, 2015
27) Park EJ, Kim CW, Cho MS, et al: Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28:2821-2831, 2014
18) Bayraktar O, Aytac E, Ozben V, et al: Does Robot Overcome Obesity-related Limitations of Minimally Invasive Rectal Surgery for Cancer? Surg Laparosc Endosc Percutan Tech 28:e8-e11, 2018
30) Park IJ, Choi GS, Lim KH, et al: Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13:275-281, 2009
26) Wang G, Wang Z, Jiang Z, et al: Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot 13:e1725, 2017
31) Ito M, Sugito M, Kobayashi A, et al: Influence of learning curve on short-term results after laparoscopic resection for rectal cancer. Surg Endosc 23:403-408, 2009
43) SPORTTM SurgicalSystem: Titan Medical Inc. http://www.titanmedicalinc.com/product/. Accessed 22 May 2019
10) Sun Y, Xu H, Li Z, et al: Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol 14:61, 2016
1) Intuitive Surgical Investor Presentation. http://phx.corporate-ir.net/phoenix.zhtml?c=122359&p=irol-irhome accessed on May 5, 2018
28) Yamaguchi T, Kinugasa Y, Shiomi A, et al: Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29:1679-1685, 2015
37) Hino H, Yamaguchi T, Kinugasa Y, et al: Robotic-assisted multivisceral resection for rectal cancer: short-term outcomes at a single center. Tech Coloproctol 21:879-886, 2017
References_xml – reference: 40) Lang S, Mattheis S, Hasskamp P, et al: A european multicenter study evaluating the flex robotic system in transoral robotic surgery. Laryngoscope 127:391-395, 2017
– reference: 14) Hellan M, Ouellette J, Lagares-Garcia JA, et al: Robotic Rectal Cancer Resection: A Retrospective Multicenter Analysis. Ann Surg Oncol 22:2151-2158, 2015
– reference: 29) Odermatt M, Ahmed J, Panteleimonitis S, et al: Prior experience in laparoscopic rectal surgery can minimise the learning curve for robotic rectal resections: a cumulative sum analysis. Surg Endosc 31:4067-4076, 2017
– reference: 43) SPORTTM SurgicalSystem: Titan Medical Inc. http://www.titanmedicalinc.com/product/. Accessed 22 May 2019
– reference: 5) Pigazzi A, Ellenhorn JD, Ballantyne GH, et al: Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521-1525, 2006
– reference: 28) Yamaguchi T, Kinugasa Y, Shiomi A, et al: Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29:1679-1685, 2015
– reference: 38) Shin US, Nancy You Y, Nguyen AT, et al: Oncologic Outcomes of Extended Robotic Resection for Rectal Cancer. Ann Surg Oncol 23:2249-2257, 2016
– reference: 17) Panteleimonitis S, Pickering O, Abbas H, et al: Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study. Int J Colorectal Dis 33:1079-1086, 2018
– reference: 16) Baukloh JK, Reeh M, Spinoglio G, et al: Evaluation of the robotic approach concerning pitfalls in rectal surgery. Eur J Surg Oncol 43:1304-1311, 2017
– reference: 33) Hottenrott C: Robotic versus laparoscopic surgery for rectal cancer and cost-effectiveness analysis. Surg Endosc 25:3954-3956; author reply 3957-3958, 2011
– reference: 12) Liao G, Li YB, Zhao Z, et al: Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence. Sci Rep 6:26981, 2016
– reference: 4) Weber PA, Merola S, Wasielewski A, et al: Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689-1694; discussion 1695-1696, 2002
– reference: 26) Wang G, Wang Z, Jiang Z, et al: Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot 13:e1725, 2017
– reference: 24) Kim HJ, Choi GS, Park JS, et al: The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity score-matched analysis with laparoscopic surgery. Colorectal Dis 20:O103-O113, 2018
– reference: 7) Prete FP, Pezzolla A, Prete F, et al: Robotic Versus Laparoscopic Minimally Invasive Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Surg 267:1034-1046, 2017
– reference: 21) Luca F, Valvo M, Ghezzi TL, et al: Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 257:672-678, 2013
– reference: 23) Broholm M, Pommergaard HC, Gogenur I: Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis 17:375-381, 2015
– reference: 15) Gorgun E, Ozben V, Costedio M, et al: Robotic versus conventional laparoscopic rectal cancer surgery in obese patients. Colorectal Dis 18:1063-1071, 2016
– reference: 36) Yamaguchi T, Kinugasa Y, Shiomi A, et al: Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc 32:4498-4505, 2018
– reference: 25) D'Annibale A, Pernazza G, Monsellato I, et al: Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27:1887-1895, 2013
– reference: 22) Lee SH, Lim S, Kim JH, et al: Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res 89:190-201, 2015
– reference: 35) Kim HJ, Choi GS, Park JS, et al: Selective lateral pelvic lymph node dissection: a comparative study of the robotic versus laparoscopic approach. Surg Endosc 32:2466-2473, 2018
– reference: 2) Fleshman J, Branda M, Sargent DJ, et al: Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA 314:1346-1355, 2015
– reference: 20) Kim J, Baek SJ, Kang DW, et al: Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching. Dis Colon Rectum 60:266-273, 2017
– reference: 37) Hino H, Yamaguchi T, Kinugasa Y, et al: Robotic-assisted multivisceral resection for rectal cancer: short-term outcomes at a single center. Tech Coloproctol 21:879-886, 2017
– reference: 11) Xiong B, Ma L, Huang W, et al: Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 19:516-526, 2015
– reference: 6) Jayne D, Pigazzi A, Marshall H, et al: Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial. JAMA 318:1569-1580, 2017
– reference: 19) Shiomi A, Kinugasa Y, Yamaguchi T, et al: Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis 31:1701-1710, 2016
– reference: 8) Li X, Wang T, Yao L, et al: The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: A meta-analysis and systematic review. Medicine (Baltimore) 96:e7585, 2017
– reference: 18) Bayraktar O, Aytac E, Ozben V, et al: Does Robot Overcome Obesity-related Limitations of Minimally Invasive Rectal Surgery for Cancer? Surg Laparosc Endosc Percutan Tech 28:e8-e11, 2018
– reference: 13) Fung A, Trabulsi N, Morris M, et al: Laparoscopic colorectal cancer resections in the obese: a systematic review. Surg Endosc 31:2072-2088, 2017
– reference: 42) Hagn U, Konietschke R, Tobergte A, et al: DLR MiroSurge: a versatile system for research in endoscopic telesurgery. Int J Comput Assist Radiol Surg 5:183-193, 2010
– reference: 31) Ito M, Sugito M, Kobayashi A, et al: Influence of learning curve on short-term results after laparoscopic resection for rectal cancer. Surg Endosc 23:403-408, 2009
– reference: 39) Spinelli A, David G, Gidaro S, et al: First experience in colorectal surgery with a new robotic platform with haptic feedback. Colorectal Dis 20:228-235, 2017
– reference: 41) Peters BS, Armijo PR, Krause C, et al: Review of emerging surgical robotic technology. Surg Endosc 32:1636-1655, 2018
– reference: 27) Park EJ, Kim CW, Cho MS, et al: Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28:2821-2831, 2014
– reference: 10) Sun Y, Xu H, Li Z, et al: Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol 14:61, 2016
– reference: 3) Stevenson AR, Solomon MJ, Lumley JW, et al: Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA 314:1356-1363, 2015
– reference: 34) Yamaguchi T, Kinugasa Y, Shiomi A, et al: Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc 30:721-728, 2016
– reference: 1) Intuitive Surgical Investor Presentation. http://phx.corporate-ir.net/phoenix.zhtml?c=122359&p=irol-irhome accessed on May 5, 2018
– reference: 30) Park IJ, Choi GS, Lim KH, et al: Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13:275-281, 2009
– reference: 32) Morgan MS, Shakir NA, Garcia-Gil M, et al: Single- versus dual-console robot-assisted radical prostatectomy: impact on intraoperative and postoperative outcomes in a teaching institution. World J Urol 33:781-786, 2015
– reference: 9) Cui Y, Li C, Xu Z, et al: Robot-assisted versus conventional laparoscopic operation in anus-preserving rectal cancer: a meta-analysis. Ther Clin Risk Manag 13:1247-1257, 2017
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Snippet ロボット支援下手術は,多関節を有する手術器具,手ぶれ防止機構やmotion scalingによる精緻な動作によって,従来の腹腔鏡手術での操作困難性などの短所を...
SourceID jstage
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StartPage 567
SubjectTerms da Vinci Surgical System
ロボット支援下手術
低侵襲手術
手術支援ロボット
直腸癌
Title IV.ロボット支援下直腸手術の現状と未来
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