Michalik Maciej, Bobowicz Maciej, Orlowski Michal
General and Vascular Surgery Department, Ceynowa Hospital, Wejherowo, Poland.
Surg Laparosc Endosc Percutan Tech. 2011 Dec;21(6):e308-10. doi: 10.1097/SLE.0b013e31823cd06b.
The aim of this study was to develop a less-invasive transanal endoscopic microsurgery (TEM) operative technique that could be applied in severely ill patients. Modified technique of TEM operation with use of the TriPort Access System in place of the operative rectoscope was designed. Harmonic scalpel and regular laparoscopic instruments were used. Resection of the rectal stump tumor was performed. A 71-year-old male patient with recurrent adenocarcinoma T2N0M0 in rectal stump and ASA 4 was operated using presented technique with good outcome. Total operating time was 25 minutes. There were no adverse events during or after the procedure. Patient was fully mobilized directly after the procedure. Proposed technique can be performed in severely ill patients as it avoids anal sphincter divulsion and therefore general anesthesia. Standard laparoscopic instruments can be used at no extra cost and no need for additional skills.
本研究的目的是开发一种侵入性较小的经肛门内镜显微手术（TEM）操作技术，该技术可应用于重症患者。设计了使用TriPort接入系统代替手术直肠镜的改良TEM手术技术。使用了谐波手术刀和常规腹腔镜器械。进行了直肠残端肿瘤切除术。一名71岁男性患者，直肠残端复发性腺癌T2N0M0，美国麻醉医师协会（ASA）分级为4级，采用本技术进行手术，效果良好。总手术时间为25分钟。手术期间及术后均未发生不良事件。术后患者立即完全恢复活动能力。所提出的技术可在重症患者中实施，因为它避免了肛门括约肌撕裂，从而避免了全身麻醉。可使用标准腹腔镜器械，无需额外费用，也无需额外技能。
