ロボット支援肺区域切除術における術中合併症と管理のビデオ分析

Robotic-assisted thoracic surgery segmentectomy is increasingly used; however, comprehensive reports on robotic-specific intraoperative complications remain limited. This study analyzed intraoperative complications during robotic-assisted lung segmentectomy across different indications, emphasizing factors unique to robotic surgery-limited visualization, lack of tactile feedback, instrument interference, and team communication-and described effective management strategies derived from detailed video-based review.

A retrospective analysis of 215 consecutive patients (169 with primary lung cancer, 38 with metastatic lung tumors, and 8 with other diseases) who underwent robotic-assisted thoracic surgery segmentectomy between July 2020 to March 2024 was conducted. Operative records and videos were reviewed to identify intraoperative complications, and detailed video-based analyses were performed to determine injury mechanisms and causes.

Intraoperative complications occurred in 19 patients (8.8%), primarily involving injuries to the pulmonary artery (n = 9, 4.2%), bronchi (n = 4, 1.9%), pulmonary vein (n = 2, 0.9%), and pleura (n = 4, 1.9%). Robotic-specific complications, attributed to limited visualization, lack of tactile feedback, stapler-related tension, instrument interference, and miscommunication, accounted for 3.3% (7 cases). All complications were managed successfully without blood transfusion or thoracotomy conversion using fibrin sealant patches, direct suturing, or additional subsegmental resection.

Video analyses identified robotic-specific challenges-limited visualization, lack of tactile feedback, instrument trouble, and miscommunication. Targeted refinements in port positioning, stapling techniques, and structured simulation training improved the safety of robotic-assisted segmentectomy.