摘要
Background. Rectal surgery is considered more technically challenging owing to its confinement in the small and narrow pelvis. Transanal surgery has been proposed as a solution to this bottleneck. However, surgical challenges remain when using present laparoscopic instruments. Robotic surgery has been developed to overcome the shortcomings of laparoscopic surgery. This paper presents our first experience in robotic transanal surgery which included transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME). Methods. Patients eligible for TAMIS included those having early rectal cancer T1 lesion with no evidence of lymphadenopathy and tumor size of less than 3 cm, or benign lesions which are not suitable for conventional transanal excisions. The selection criteria for patients receiving TaTME included low rectal lesions with no evidence of external sphincter or levator ani invasion, and body mass Index (BMI) ≤ 25 kg/m^2. Results. Between March 2015 and October 2016, 27 patients who received robotic transanal surgery were enrolled in the present study. Fifteen patients underwent robotic TaTME for low rectal cancer, and 12 patients received robotic TAMIS for middle to low rectal lesions. For the TAMIS group, the mean operating time was 145 min (range: 60-210) and the mean postoperative hospital stay was 4.4 days (range: 1-10). For the TaTME group, the mean tumor distance between tumor and anal verge was 3.3 cm (range: 2.0-5.0) and the median operating time was 473 min (range: 335-569). Left ureteral transection was encountered in one patient intraoperatively, and another patient required reoperation for postoperative adhesive intestinal obstruction. There was no 30-day mortality. Conclusions. Transanal approach offered a new concept and technique in rectal surgery for its better tumor radicality. However, this approach is relatively new and unfamiliar to colorectal surgeons. More acquaintance with surgical anatomy and carefully patient selection are keys to improveing the quality of transanal surgery and decreasing morbidity for inexperienced surgeons with this new and innovative operation.
並列摘要
直腸手術由於骨盆腔空間狹小因而增加困難度，採用經肛門的方式可以改善手術難易，但目前現行的腹腔鏡器械行經肛門手術仍有活動限制，所以達文西機械手臂的靈活關節便提供良好的手術操控，進而達到完整切除病灶的目標，本篇的研究是分享單一醫療機構的經肛門達文西機械手臂手術成果。