ObjectiveTo analyze whether transanal total mesorectal excision (taTME) can achieve high-quality TME, explore the non-patient factors affecting the quality of taTME, improve the quality of taTME.MethodsThe clinical data of 76 patients undergoing taTME from January 2015 to September 2018 in the Department of Gastrointestinal Surgery of Nanchong Central Hospital were retrospectively analyzed. The operative time, intra-operative bleeding volume, positive rate of circumferential margin, integrity of mesorectum, positive rate of margin and complications were taken as the observation indexes of operative quality. The improvement of surgical equipment, structured training, and the accumulation of surgical cases (No. 1–25 cases was early group, No. 26–50 cases was mid-term group, No. 51–76 cases was later stage group) were compared as grouping conditions, and various factors affecting the quality of taTME were analyzed.Results① Pre- and post-the improvement of surgical equipment: compared to the pre-improvement of surgical equipment group, the distance between tumors and anal margin of patients in the post-improvement of surgical equipment was closer ［(4.9±1.3) cm vs. (5.9±2.7) cm, P=0.040］ and the postoperative hospital stay was shorter ［(10.6±3.9) d vs. (12.4±2.7) d, P=0.023］, while there were no significant difference in the amount of bleeding, the positive rate of circumferential margin, the integrity of mesorectum, the positive rate of margin and the complications in the two groups (P>0.05). ② Pre- and post-training for surgeon: compared to the pre-training group, the operative time in the post-training group was shortened ［(224.6±70.2) min vs. (275±77.0) min, P=0.020］, while there were no statistical differences in the amount of bleeding, the integrity of mesorectum, the difference of the positive rate of circumferential margin, the positive rate of distal margin, postoperative complications and postoperative hospital stay (P>0.05). ③ The cumulative grouping of cases: compared to the later stage group ［（218.8±69.5）min］, the operative time in the early group ［(275.2±82.6) min］ and the mid-term group ［(278.8±37.5) min］ were shortened with statistical difference (P=0.022, P=0.003). Moreover, compared to the early group ［(12.9±2.4) d］, the postoperative hospital stay in the mid-term group ［(10.8±4.0) d］ and the later stage group ［(10.2±3.6) d］ were shortened with statistical significance (P=0.032, P=0.007). However, there were no significant difference in the volume of bleeding, the positive rate of circumferential margin, the positive rate of incisal margin and the degree of mesangial integrity among the three groups (P>0.05).ConclusionstaTME can achieve high-quality TME. With the improvement of equipment, the participation of structured training and the accumulation of surgical cases, taTME achieved consistent quality in about 50 cases. The improvement of surgical equipment is the guarantee of the quality of taTME. Structured training is the key to improve the surgical quality of taTME.
Objective To investigate the benefits of using a stapler tractor in the treatment of segmental bronchus during lung segmentectomy through detailed video replay analysis of surgical procedures. Methods We collected data from patients who underwent segmentectomy performed by the same surgical team in the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, from November 2020 to August 2023. After excluding data that lacked analysis parameters, the remaining patients were divided into four groups based on the methods used for dissociating segmental bronchus: a stapler tractor group (group A), a stapler with bronchial stretching group (group B), a stapler only group (group C), and a silk ligature group (group D). Then, we compared baseline data and videotaped surgical details across all groups. Surgical details included the success rate of one-time segmental bronchus dissociation and severance, the time taken for successful one-time dissociation and severance of the segmental bronchus, the incidence of bleeding during bronchus dissociation, the conversion rate to thoracotomy during surgery, and surgical outcomes such as total operative time, postoperative hospitalization days, postoperative thoracic drainage volume, and pulmonary air leakage rate. Results The study included 325 patients (203 in the group A, 62 in the group B, 29 in the group C, and 31 in the group D). There was no statistically significant difference in baseline data among the four groups. However, significant differences were found in terms of total operation time, postoperative hospitalization days, intraoperative blood loss, segmental bronchial stump length, postoperative air leakage rate, hemorrhage rate during segmental bronchial dissociation, and conversion to thoracotomy rate among the four groups (P<0.05). ConclusionUsing a stapler tractor for dissociating segmental bronchus in lung segmentectomy results in shorter operative time, less risk of intraoperative bleeding, and less surgical complications. This study provides valuable evaluation methodologies through the analysis of video replay surgical details, contributing to the improvement of lung segmentectomy quality.