Objective: To explore the application of the camera inversion technique in laparoscopic sphincter-preserving surgery for mid to low rectal cancer. Methods: A retrospective study with historical controls was conducted on patients with non-metastatic mid to low rectal cancer which received laparoscopic total mesorectal excision at Peking Union Medical College Hospital from January 2019 to June 2024. The experimental group (2021.7-2024.6) utilized the camera inversion technique (rotating the lens 180° to position the bevel upward and switching the system to reverse display mode for improved visualization and operative angles) during key surgical steps (such as intraoperative mobilization of the mid-to-lower rectum and anastomosis), while the control group (2019.1-2021.6) did not. Clinical data and surgical videos were collected to analyze indicators like operative time, blood loss, mesorectal integrity, surgical complications, and postoperative hospital stay. Results: A total of 624 patients with non-metastatic mid to low rectal cancer were included, including 412 males and 212 females, with an average age of 59.8 years and an average tumor distance of 5.6 cm from the anal verge. The experimental group comprised 301 patients, while the control group had 323 patients.The proportion of abdominal ISR (intersphincteric resection) was significantly higher in the experimental group [19.3% (58/301) vs. 10.2%(33/323), χ2=10.140, P=0.001], with a reduction in operative time [(161.8±67.8) minutes vs. (150.2±68.5) minutes, t=2.134, P=0.033] and a decrease in postoperative hospital stay [(7.8±2.1) days vs. (8.3±3.4) days, t=2.003, P=0.046]. The experimental group also demonstrated advantages in intraoperative blood loss, mesorectal integrity rate, and postoperative complications such as urinary retention, though these differences were not statistically significant (all P>0.05). Conclusion: In laparoscopic surgery for mid to low rectal cancer, using camera inversion technique during distal rectum dissection and transanal anastomosis can provide better surgical field exposure, facilitate precise operations within the correct anatomical plane, and minimize collateral damage. The camera inversion technique is safe and effective.
目的： 探讨镜头翻转技术在腹腔镜中低位直肠癌保肛手术中的应用及其效果。 方法： 采用回顾性历史对照研究方法，收集2019年1月至2024年6月期间，北京协和医院基本外科接受腹腔镜全直肠系膜切除术的非转移性中低位直肠癌手术患者的临床资料。根据手术方法，将患者分为镜头翻转组（2021年7月至2024年6月的入组患者，采用镜头翻转技术）和常规组（2019年1月至2021年6月的入组患者，未采用镜头翻转技术），镜头翻转组于术中游离直肠中下段及吻合等关键环节采用“镜头翻转技术”（将镜头翻转180°使得斜面向上，并将系统调整为反向显示模式），而常规组未采用该技术。收集并对比两组患者临床资料和手术录像，分析手术时间、出血量、系膜完整程度以及术后并发症、术后住院时间等指标。 结果： 共纳入中低位直肠癌患者共624例，男性412例，女性212例。平均年龄59.8岁，肿瘤距肛缘平均距离5.6 cm。采用镜头翻转技术的患者301例（镜头翻转组），常规组患者323例。与常规组相比，镜头翻转组行经腹经括约肌间切除比例更高［19.3%（58/301）比10.2%（33/323），χ²=10.140，P=0.001］，手术时间更少［（161.8±67.8）min比（150.2±68.5）min，t=2.134，P=0.033］，住院时间更短［（7.8±2.1）d比（8.3±3.4）d，t=2.003，P=0.046］。镜头翻转组在术中出血量、系膜完整率以及尿潴留等术后并发症方面也优于常规组，但差异无统计学意义（均P>0.05）。 结论： 在中低位直肠癌腹腔镜手术中，游离直肠中下段和经肛吻合时采用镜头翻转技术，可以更好的显露术野，利于超低位保肛，安全有效。.