Araujo Sergio Eduardo Alonso, Mendes Carlos Ramon Silveira, Carvalho Gustavo Lopes, Lyra Marcos
Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil,
Surg Endosc. 2015 Aug;29(8):2331-8. doi: 10.1007/s00464-014-3956-1. Epub 2014 Dec 25.
Several issues have limited the widespread adoption of transanal endoscopic microsurgery (TEM). The need for specialized equipment and the steep learning curve represent one of them. To operate on within a 4-cm diameter, rectoscope represents a major technical challenge. However, minilaparoscopic surgery has been introduced to reduce invasiveness and abdominal wall trauma. In TEM, instrument miniaturization may lead to technique optimization. We hypothesized that visualization and maneuverability during TEM performed with 3-mm minilaparoscopic instruments would be superior to TEM performed with conventional 5-mm instruments.
Eighteen general and colorectal surgeons with experience with TEM under ten cases were recruited. Two tasks should be accomplished using the TEO(®)-Neoderma simulator. First, using conventional 5-mm TEO(®) curved-tip instruments, a "polypoid lesion" should be excised. Next, closure of the "rectal" defect should be undertaken. In the second part, the same participants repeated the same excision/closure tasks using 3-mm minilaparoscopic instruments. After tasks conclusion, participants fulfilled an evaluation questionnaire with seven questions regarding visualization and maneuverability when using 3-mm compared to 5-mm instruments.
For each one of the seven questions in the questionnaire, the score results were significantly higher for the 3-mm instruments indicating that performance with the 3-mm minilaparoscopic instruments in the TEO simulator was in all cases between "better than expected" and "much better than expected." Appropriateness of the diameter of the minilaparoscopic instruments was the best evaluated parameter. The question addressing the ease of performing the tasks in the simulator presented the lowest mean score.
The perceptions of participating surgeons indicated that there is better visualization and maneuverability during basic transanal endoscopic microsurgery tasks conducted in a simulator using 3-mm minilaparoscopic instruments when compared to conventional 5-mm instruments.
多个问题限制了经肛门内镜显微手术（TEM）的广泛应用。对专用设备的需求以及陡峭的学习曲线就是其中之一。要在直径4厘米范围内进行手术，直肠镜是一项重大技术挑战。然而，微型腹腔镜手术已被引入以减少侵袭性和腹壁创伤。在TEM中，器械小型化可能会带来技术优化。我们假设，使用3毫米微型腹腔镜器械进行TEM时的可视化和可操作性将优于使用传统5毫米器械进行的TEM。
招募了18名有10例TEM经验的普通外科和结直肠外科医生。应使用TEO（®）-Neoderma模拟器完成两项任务。首先，使用传统的5毫米TEO（®）弯尖器械切除一个“息肉样病变”。接下来，应进行“直肠”缺损的闭合。在第二部分中，相同的参与者使用3毫米微型腹腔镜器械重复相同的切除/闭合任务。任务完成后，参与者填写一份评估问卷，其中有七个关于使用3毫米器械与5毫米器械相比时的可视化和可操作性的问题。
对于问卷中的七个问题中的每一个，3毫米器械的得分结果都显著更高，这表明在TEO模拟器中使用3毫米微型腹腔镜器械的操作在所有情况下都介于“比预期好”和“比预期好得多”之间。微型腹腔镜器械直径的适宜性是评估最佳的参数。关于在模拟器中执行任务的难易程度的问题得分最低。
参与研究的外科医生的看法表明，与传统的5毫米器械相比，在模拟器中使用3毫米微型腹腔镜器械进行基本经肛门内镜显微手术任务时，可视化和可操作性更好。
