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首页> 外文期刊>Surgical Endoscopy >TransAnal Minimally Invasive Surgery (TAMIS) with SILS? Port versus Transanal Endoscopic Microsurgery (TEM): A comparative experimental study
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TransAnal Minimally Invasive Surgery (TAMIS) with SILS? Port versus Transanal Endoscopic Microsurgery (TEM): A comparative experimental study

机译：带SILS的经肛门微创手术（TAMIS）？港口与经肛门内窥镜显微外科手术（TEM）：对比实验研究

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Background: TransAnal Minimally Invasive Surgery (TAMIS) has been proposed as an alternative to Transanal Endoscopic Microsurgery (TEM) for resection of benign polyps and early cancers of rectum. Since clinical application has begun in the absence of any experimental validation, we assessed its feasibility and efficacy ex vivo in a pilot study. Methods: In a dedicated trainer box for transanal procedures, 10 surgeons with no experience in transanal surgery were asked to perform a dissection/suture task using both TAMIS and TEM in randomly allocated order. Surgeons were asked to dissect two identically drawn lesions of ~3 cm in larger diameter. Precision of dissection was assessed using a quantitative photographic method, while the time needed for dissection and suturing was considered a measure of quantitative evaluation. Each participant expressed a subjective opinion regarding difficulty with dissection, difficulty with suturing, vision quality, and conflict between instruments on a scale from 1 to 5. Results: No difference was observed between the two techniques regarding the accuracy of dissection as the margin was interrupted along 4.1 % of the circumference in the TEM group compared with 2.48 % in the SILS group (P = 0.271). Dissection and suturing were significantly quicker in the TEM group [04:30 vs. 06:35 min (P = 0.049) and 14:34 versus 19:18 min (P = 0.003)]. In three cases in the SILS group, completing the suture was not considered possible, and the procedures were terminated by TEM. Subjective evaluation revealed a better appreciation of TEM in all proposed comparisons: dissection (2.6 vs. 3.5, P = 0.004), suturing difficulty (3.1 vs. 4.6, P < 0.001), quality of vision (2.3 vs. 2.8, P = 0.18), and instrument conflicts (3.1 vs. 4.0, P = 0.054). Conclusions: In the ex vivo setting, both techniques were comparable for achieving a good dissection, although TAMIS failed to prove effective in suturing the rectal wall. Moreover, TEM was significantly quicker despite the small groups and was better appreciated by the surgeons.
机译：背景：经肛门微创手术（TAMIS）已被提议作为经肛门内镜显微外科手术（TEM）的替代方法，用于切除良性息肉和直肠癌。由于临床应用是在没有任何实验验证的情况下开始的，因此我们在一项先导研究中评估了其可行性和体外疗效。方法：在一个专门的经肛门手术教练箱中，要求10名没有经肛门手术经验的外科医生以随机分配的顺序同时使用TAMIS和TEM进行解剖/缝合任务。要求外科医生解剖两个直径约3 cm的相同绘制的病变。使用定量照相方法评估解剖的准确性，而将解剖和缝合所需的时间视为定量评估的一种手段。每个参与者对主动脉夹层困难，缝合困难，视力质量以及器械之间的冲突以1到5的等级表示主观意见。结果：由于切缘的中断，两种方法在解剖的准确性上均未观察到差异TEM组的周长为4.1％，而SILS组的周长为2.48％（P = 0.271）。 TEM组的解剖和缝合明显更快[04:30 vs. 06:35 min（P = 0.049）和14:34 vs 19:18 min（P = 0.003）]。 SILS组中有3例认为完成缝合是不可能的，并且该程序已被TEM终止。主观评估显示，在所有拟议的比较中，TEM都得到了更好的理解：解剖（2.6 vs. 3.5，P = 0.004），缝合难度（3.1 vs. 4.6，P <0.001），视力质量（2.3 vs. 2.8，P = 0.18） ）和仪器冲突（3.1 vs. 4.0，P = 0.054）。结论：在离体设置中，尽管TAMIS未能证明有效地缝合直肠壁，但两种技术在实现良好的解剖效果方面具有可比性。此外，尽管小组很小，但TEM的速度明显更快，外科医生对此也更加赞赏。

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