Walensi Mikolaj, Käser Samuel A, Theodorou Panagiotis, Bassotti Gabrio, Cathomas Gieri, Maurer Christoph A
Department of Surgery, Hospital of Liestal, Affiliated with the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland,
World J Surg. 2014 Feb;38(2):505-11. doi: 10.1007/s00268-013-2264-6.
Transanal endoscopic microsurgery (TEM) is an established method for the resection of benign and early malignant rectal lesions. Very recently, TEM via an anally inserted single incision laparoscopic surgery (SILS(®))-port has been proposed to overcome remaining obstacles of the classical TEM equipment.
Nine patients with a total of 12 benign or early stage malignant rectal polyps were operated using the SILS(®)-port for TEM. Patients' and polyps' characteristics, perioperative and postoperative complications, as well as operating and hospitalization time were recorded.
All 12 polyps (ten low-grade adenoma, one high-grade adenoma, one pT2 carcinoma [preoperatively staged as T1]) were resected. Local full-thickness bowel wall resection was performed for three lesions and submucosal resection for nine lesions. Median operating time was 64 (range 30-180) min. No conversion to laparoscopic or open techniques was necessary. The median maximum diameter of the specimen was 25 (range 3-60) mm, fragmentation of polyps was avoidable in 11 of 12 (92 %) lesions, and resection margins were histologically clear in 11 of 12 (92 %) polyps. Only one patient, in whom three lesions were resected, experienced a complication as postoperative hemorrhage. No mortality occurred. Median hospitalization time was four (range 1-14) days.
SILS(®)-TEM is a feasible and safe method, providing numerous advantages in application, handling, and economy compared with the classical TEM technique. SILS(®)-TEM might become a promising alternative to classical TEM. Randomized, controlled trials comparing safety and efficacy of both instrumental settings will be needed in the future.
经肛门内镜显微手术（TEM）是一种用于切除直肠良性及早期恶性病变的成熟方法。最近，有人提出通过经肛门插入的单孔腹腔镜手术（SILS(®)）端口进行TEM，以克服传统TEM设备存在的障碍。
9例患者共12个直肠良性或早期恶性息肉接受了使用SILS(®)端口的TEM手术。记录患者及息肉的特征、围手术期和术后并发症，以及手术时间和住院时间。
12个息肉（10个低级别腺瘤、1个高级别腺瘤、1个pT2癌[术前分期为T1]）均被切除。3个病变行局部肠壁全层切除，9个病变行黏膜下切除。中位手术时间为64（范围30 - 180）分钟。无需转为腹腔镜或开放手术。标本的中位最大直径为25（范围3 - 60）mm，12个病变中有11个（92%）可避免息肉破碎，12个息肉中有11个（92%）的切除边缘在组织学上清晰。仅1例切除3个病变的患者出现术后出血并发症。无死亡病例。中位住院时间为4（范围1 - 14）天。
SILS(®)-TEM是一种可行且安全的方法，与传统TEM技术相比，在应用、操作和经济性方面具有诸多优势。SILS(®)-TEM可能成为传统TEM的一种有前景的替代方法。未来需要进行随机对照试验，比较两种器械设置的安全性和有效性。
