臨床外科73巻6号

2018年06月発行

特集 こうやって教える・学ぶ　高難度消化器外科手術—新エキスパートへの登竜門 肝胆膵

腹腔鏡下肝切除

著者： 伴大輔¹ 小倉俊郎¹ 小川康介¹ 小野宏晃¹ 光法雄介¹ 工藤篤¹ 田邉稔¹

所属機関： ¹東京医科歯科大学肝胆膵外科学

ページ範囲：P.718 - P.723

【ポイント】
◆マネジメント：保険収載の適応拡大に伴って安全性に配慮した腹腔鏡下肝切除の導入が求められる．Difficulty Scoring Systemによる症例選択や，learning curveに配慮したトレーニングシステムを構築する必要がある．
◆基本手技：チーム・施設の実情に合わせて適切なデバイスを選択し，CUSA法やClamp-crushing法などの手技を定型化することが肝要である．

参考文献

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2）Ban D, Tanabe M, Ito H, et al：A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21：745-753, 2014

3）Uchida H, Iwashita Y, Saga K, et al：Clinical Utility of the Difficulty Scoring System for Predicting Surgical Time of Laparoscopic Liver Resection. J Laparoendosc Adv Surg Tech A 26：702-706, 2016

4）Tanaka S, Kubo S, Kanazawa A, et al：Validation of a Difficulty Scoring System for Laparoscopic Liver Resection：A Multicenter Analysis by the Endoscopic Liver Surgery Study Group in Japan. J Am Coll Surg 225：249-258 e241, 2017

5）Tzeng CD, Vauthey JN：Evaluation of New Classifications for Liver Surgery：Can Anatomic Granularity Predict Both Complexity and Outcomes of Hepatic Resection? Ann Surg 267：24-25, 2018

6）Hasegawa Y, Wakabayashi G, Nitta H, et al：A novel model for prediction of pure laparoscopic liver resection surgical difficulty. Surg Endosc 2017

7）Kawaguchi Y, Fuks D, Kokudo N, et al：Difficulty of Laparoscopic Liver Resection：Proposal for a New Classification. Ann Surg 2017

8）Lin CW, Tsai TJ, Cheng TY, et al：The learning curve of laparoscopic liver resection after the Louisville statement 2008：Will it be more effective and smooth? Surg Endosc 30：2895-2903, 2016

9）Nomi T, Fuks D, Kawaguchi Y, et al：Learning curve for laparoscopic major hepatectomy. Br J Surg 102：796-804, 2015

10）Hasegawa Y, Nitta H, Takahara T, et al：Safely extending the indications of laparoscopic liver resection：When should we start laparoscopic major hepatectomy? Surg Endosc 31：309-316, 2017

11）Yamada S, Shimada M, Imura S, et al：Effective stepwise training and procedure standardization for young surgeons to perform laparoscopic left hepatectomy. Surg Endosc 31：2623-2629, 2017