Study for usefulness and safty management of robotic surgery for lung cancer with using CO2 insufflation technique

Research Project

Project/Area Number	17K10783
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Research Field	Respiratory surgery
Research Institution	Tottori University
Principal Investigator	NAKAMURA Hiroshige 鳥取大学, 医学部, 教授 (30252852)
Co-Investigator(Kenkyū-buntansha)	谷口雄司鳥取大学, 医学部附属病院, 教授 (10304239) 三和健鳥取大学, 医学部附属病院, 助教 (40419495)
Project Period (FY)	2017-04-01 – 2021-03-31
Project Status	Completed (Fiscal Year 2020)
Budget Amount *help	¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000) Fiscal Year 2019: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000) Fiscal Year 2018: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000) Fiscal Year 2017: ¥2,600,000 (Direct Cost: ¥2,000,000、Indirect Cost: ¥600,000)
Keywords	胸腔鏡手術 / ロボット支援手術 / 気胸法 / 胸腔内CO2送気 / 有効性と安全性 / 肺癌 / CO2送気 / 出血予防 / 臓器保護効果 / 肺外科
Outline of Final Research Achievements	Experiments using pigs have been conducted to verify that (1) pneumothorax method using CO2 gas air is improved in the surgical operability when performing thoracoscopic surgery or robot-assisted surgery, and (2) the effect of reducing the amount of bleeding has been performed. The results showed that CO2 pressure of 5 to 10 mmHg in the thoracic cavity maintained respiratory and circulatory dynamics and enlarged the thoracic space, and the effect of suppressing bleeding during pulmonary artery injury was also observed. At 15 mmHg or more, the effect of suppressing bleeding was even more remarkable, but there was a decrease in oxygen saturation and blood pressure, and one of them also had cardiac arrest during the experiment, and it was impossible to maintain respiratory and circulatory dynamics. This study showed the usefulness of pneumothorax method using CO2 gas air.
Academic Significance and Societal Importance of the Research Achievements	CO2送気による気胸法の有用性と安全性が、ブタの実験を通して検証できた。特に、胸腔鏡手術やロボット支援手術における適正圧を確認できた点で学術的意義は大きい。また、現在急速に普及しているロボット支援手術を推進する上でも社会的意義が大きい。しかしながら、本研究ではあくまでブタでの実験であり、必ずしも人を対象とした実臨床においての適正圧とは言えない。人では一人一人の病状や特性が異なるため、呼吸・循環系への影響は個体差が大きくなることを考慮し、今後は実臨床での経験症例を蓄積して、有効性と安全性を検証することが大切である。