Shen Zhanlong, Ye Yingjiang, Atallah Sam, Xie Qiwei, Jiang Kewei, Wang Shan
Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2015 Oct;18(10):998-1001.
Transanal minimally invasive surgery (TAMIS) is a novel minimally invasive procedure which is performed by normal laparoscopic instruments through the single port transanally. Three kinds of procedures have been performed based on the TAMIS platform by now, including TAMIS-TME(total mesorectal excision), TAMIS-APE(Abdominoperineal excision) and TAMIS-Hartmann. Transanal total mesorectal excision (taTME) with dissection from bottom to up through the platform of TAMIS is also called TAMIS-TME. The greatest advantage of TAMIS-TME is that it increases the quality of specimen and decrease the adverse injury due to the sufficient vision of lower part of mesorectum in the operation. TAMIS-APE and TAMIS-Hartmann procedures emerge after the experience of TAMIS-TME. TAMIS-APE procedure not only firstly make the dissection of perineal phase minimally invasive, but also make the perineal vision more clear, the resection of levator ani muscle more precise, eventually the tailored APE procedure comes true under the laparoscopy of perineal phase. The dissection of mid-low mesorectum for recurrent tumor is usually difficult just from above, TAMIS facilitates the resection through entering the normal anatomical space under the tumor. If the tumor has the risk of recurrence, distal rectum is closed and proximal colostomy is made, we firstly performed this procedure and name it TAMIS-Hartmann. Therefore, TAMIS is not only a platform for taTME, but also it provides a transanal approach and a "button to up" conception for the mid-low rectal tumor.
经肛门微创手术（TAMIS）是一种新型的微创手术，通过单孔经肛门使用常规腹腔镜器械进行操作。目前基于TAMIS平台已开展了三种手术，包括TAMIS-TME（全直肠系膜切除术）、TAMIS-APE（腹会阴联合切除术）和TAMIS-哈特曼手术。经肛门全直肠系膜切除术（taTME）通过TAMIS平台由下向上进行分离，也被称为TAMIS-TME。TAMIS-TME的最大优势在于，手术中直肠系膜下部视野充分，提高了标本质量并减少了不良损伤。TAMIS-APE和TAMIS-哈特曼手术是在TAMIS-TME经验基础上出现的。TAMIS-APE手术不仅首次使会阴阶段的分离实现了微创，还使会阴视野更清晰，肛提肌切除更精确，最终在会阴阶段腹腔镜下实现了个体化的APE手术。对于复发性肿瘤，仅从上方进行中低位直肠系膜分离通常很困难，TAMIS通过进入肿瘤下方的正常解剖间隙便于切除。如果肿瘤有复发风险，关闭直肠远端并进行近端结肠造口术，我们首次开展了此手术并将其命名为TAMIS-哈特曼手术。因此，TAMIS不仅是taTME的一个平台，还为中低位直肠肿瘤提供了一种经肛门入路和“由下向上”的理念。
