Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
School of Medicine, University of California San Francisco, San Francisco, CA, USA.
BMC Surg. 2022 Mar 27;22(1):117. doi: 10.1186/s12893-022-01543-w.
Robotic transanal minimally invasive surgery (R-TAMIS) is an appealing alternative to transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery (TEM) for benign and early malignant rectal lesions that are not amenable to traditional open transanal excision. However, no studies to our knowledge have directly compared the three techniques. This study sought to compare peri-operative and pathologic outcomes of the three approaches.
The records of 29 consecutive patients who underwent TEM, TAMIS, or R-TAMIS at a single academic center between 2016 and 2020 were reviewed. Intra-operative details, pathological diagnosis and margins, and post-operative outcomes were recorded. The three groups were compared using chi-square and Kruskal-Wallis tests.
Overall, 16/29 patients were women and the median age was 57 (interquartile range (IQR): 28-81). Thirteen patients underwent TEM, six had TAMIS, and 10 had R-TAMIS. BMI was lower in the R-TAMIS patients (24.7; IQR 23.8-28.7), than in TEM (29.3; IQR 19.9-30.2), and TAMIS (30.4; IQR 26.6-32.9) patients. High grade dysplasia and/or invasive cancer was more common in TAMIS (80%) and R-TAMIS (66.7%) patients than in TEM patients (41.7%). The three groups did not differ significantly in tumor type or distance from the anal verge. No R-TAMIS patients had a positive surgical margin compared to 23.1% in the TEM group and 16.7% in the TAMIS group. Length of stay (median 1 day for TEM and R-TAMIS patients, 0 days for TAMIS patients) and 30-day readmission rates (7.7% of TEM, 0% of TAMIS, 10% of R-TAMIS patients) also did not differ among the groups. Median operative time was 110 min for TEM, 105 min for TAMIS, and 76 min for R-TAMIS patients.
R-TAMIS may have several advantages over other advanced techniques for transanal excisions. R-TAMIS tended to be faster and to more often result in negative surgical margins compared to the two other techniques.
对于不适合传统经肛门切除的良性和早期直肠恶性病变，机器人经肛门微创手术（R-TAMIS）是经肛门微创手术（TAMIS）和经肛门内镜微创手术（TEM）的一种有吸引力的替代方法。然而，据我们所知，没有研究直接比较这三种技术。本研究旨在比较这三种方法的围手术期和病理结果。
回顾了 2016 年至 2020 年期间在一家学术中心接受 TEM、TAMIS 或 R-TAMIS 的 29 例连续患者的记录。记录了术中细节、病理诊断和切缘以及术后结果。使用卡方检验和 Kruskal-Wallis 检验比较三组。
总体而言，29 例患者中 16 例为女性，中位年龄为 57 岁（四分位距（IQR）：28-81）。13 例患者接受 TEM，6 例行 TAMIS，10 例行 R-TAMIS。R-TAMIS 患者的 BMI 较低（24.7；IQR 23.8-28.7），低于 TEM（29.3；IQR 19.9-30.2）和 TAMIS（30.4；IQR 26.6-32.9）患者。TAMIS（80%）和 R-TAMIS（66.7%）患者的高级别发育不良和/或浸润性癌比 TEM 患者（41.7%）更常见。三组患者的肿瘤类型或距肛门缘的距离无显著差异。与 TEM 组的 23.1%和 TAMIS 组的 16.7%相比，R-TAMIS 组无患者的手术切缘阳性。TEM 和 R-TAMIS 患者的住院时间（中位 1 天）和 30 天再入院率（TEM 组为 7.7%，TAMIS 组为 0%，R-TAMIS 组为 10%）也无差异。TEM 组的中位手术时间为 110 分钟，TAMIS 组为 105 分钟，R-TAMIS 组为 76 分钟。
与其他经肛门切除的先进技术相比，R-TAMIS 可能具有一些优势。与其他两种技术相比，R-TAMIS 往往更快，并且更常导致阴性手术切缘。
