ロボット支援肝切除におけるスコープ遷移テクニック：単一施設での経験

Robotic liver resection (RLR) has seen rapidly expanding indications, with its utility widely reported. However, a major limitation is the restricted view due to the rigid endoscope. This study aimed to evaluate the effectiveness of the scope-transition technique in optimizing the surgical field during RLR.

We retrospectively analyzed 73 consecutive patients who underwent RLR at our institution between October 2022 and September 2024, focusing on scope transition. Two standardized port configurations were used based on the side of the liver resected. When optimal visualization was difficult during resection, the scope was relocated to an alternate port to improve the field. Parenchymal transection was primarily performed using the clamp-crushing method under the Pringle maneuver, with adjunctive use of an assistant-controlled CUSA when the transection plane was extensive.

Scope transition was used 41 times in 23 patients (32%), primarily for transection plane visualization (56%), liver mobilization (29%), and multiple-lesion resection (15%). The median transition duration was 80 s (range: 23-217). No intraoperative complications or conversions to open surgery occurred. The median operative time was 211 min, and median blood loss was 40 mL. Clavien-Dindo grade II complications occurred in 7 patients (10%), with no grade III or higher complications. The median hospital stay was 7 days. All resections achieved R0 status.

Scope transition is a safe and effective method to enhance visualization and surgical feasibility during RLR.