Center for Colon and Rectal Surgery, Florida Hospital Orlando, Orlando, FL 32803, USA.
Surg Endosc. 2010 Sep;24(9):2200-5. doi: 10.1007/s00464-010-0927-z. Epub 2010 Feb 21.
Our novel approach is a hybrid between transanal endoscopic microsurgery (TEM) and single-port laparoscopy that we have termed TransAnal Minimally Invasive Surgery (TAMIS). We report the clinical application of this technique and present preliminary data that show TAMIS to be an effective tool for resection of both malignant and benign lesions of the rectum.
Over a 3-month period (May-July 2009) all patients with rectal lesions who were candidates for conventional transanal excision were offered the option to undergo TAMIS resection. Patients with biopsy-proven malignant lesions were required to undergo endorectal ultrasound preoperatively to determine tumor stage. To perform TAMIS, a single-incision laparoscopic surgery port (SILS Port, Covidien) is introduced into the anal canal by applying steady manual pressure. Once seated in position, endoscopic access to the rectal vault is gained and pneumorectum is established. With this access, ordinary laparoscopic instruments, including graspers, thermal energy devices, and needle drives, are used to perform the transanal excisions.
Six patients, aged 43-85 years old (mean = 59.8), underwent TAMIS resection of rectal lesions. The average distance from the anal verge was 9.3 cm and the mean tumor diameter confirmed by pathology measured 2.93 cm. There were no conversions from TAMIS to conventional transanal excision. While the average operating time was 86 min, four of the six TAMIS resections (67%) were completed in less than 1 h. The mean set-up time was only 1.9 min and this may be one reason that the mean operative time was considerably less than the average operative time for TEM surgery (120-140 min). In short-term follow-up, there was no morbidity or mortality observed.
TAMIS is a feasible alternative to TEM, providing its benefits at a fraction of the cost.
我们的新方法是经肛门内镜微创手术（TEM）和单孔腹腔镜的混合，我们称之为经肛门微创外科（TAMIS）。我们报告了该技术的临床应用，并提供了初步数据，表明 TAMIS 是切除直肠良恶性病变的有效工具。
在 3 个月的时间内（2009 年 5 月至 7 月），所有适合经肛门切除的直肠病变患者都可以选择接受 TAMIS 切除。术前需要对经直肠超声证实为恶性病变的患者进行术前检查以确定肿瘤分期。为了进行 TAMIS，通过施加稳定的手动压力将单切口腹腔镜手术端口（SILS 端口，Covidien）引入肛门管。一旦定位就位，即可获得直肠穹窿的内镜通道并建立气直肠。通过这种进入途径，可以使用普通腹腔镜器械，包括抓握器、热能装置和针驱动器来进行经肛门切除。
六名年龄 43-85 岁（平均年龄 59.8 岁）的患者接受了直肠病变的 TAMIS 切除。从肛门缘的平均距离为 9.3 厘米，病理证实的平均肿瘤直径为 2.93 厘米。没有从 TAMIS 转为传统的经肛门切除。虽然平均手术时间为 86 分钟，但六例 TAMIS 切除中有四例（67%）在 1 小时内完成。平均设置时间仅为 1.9 分钟，这可能是手术时间明显短于 TEM 手术平均手术时间（120-140 分钟）的原因之一。短期随访无发病率或死亡率。
TAMIS 是 TEM 的可行替代方案，其成本仅为 TEM 的一小部分。
