摘要近年来,我国微创外科取得了前所未有的发展,经自然腔道取标本手术(NOSES)、经自然腔道内镜手术(NOTES)和经肛全直肠系膜切除术(taTME)作为微创外科3种最具代表性的新技术,因具有良好的微创优势,在我国外科领域备受热议和追捧.诚然,这3种技术仍处于发展的早期阶段,各自也都面临着很多问题和挑战.因此,我们必须在定义准确、概念明晰、操作规范的前提下,全面深入地认识这些技术,切勿盲目跟从,更不能混淆概念和术式名称,这也是微创技术科学有序开展的重要前提和根本保障.NOSES重点强调经自然腔道完成标本取出,而NOTES主要强调采用自然腔道作为手术入路进入体腔,taTME强调的是经肛门入路.NOSES与NOTES是两个广义的外科学概念,适用于各种组织器官,而taTME则是仅局限于直肠的狭义外科学概念.三者的主要宗旨都是在保证疾病有效治疗的基础上,最大程度展示出良好的微创效果.从当前的技术条件来看,没有哪一种手术技术是完美无缺的,只有根据患者病情的需要,选择最佳的手术方式,才能将微创技术的优势发挥到极致,才能让患者最大程度受益.

abstractsIn recent years, our country has gained unprecedented achievements in minimally invasive surgery. Natural orifice specimen extraction surgery (NOSES), natural orifice transluminal endoscopic surgery (NOTES) and transanal total mesorectal excision (TaTME) are the three most representative techniques for minimally invasive surgery. They are hot in Chinese surgical field due to their superior minimally invasive advantages. It is true that these three technologies are still in their early stages of development. Each of them also faces many problems and challenges that need to be resolved and overcome. Therefore, it is necessary for us to understand these technologies thoroughly on the premise of accurate definitions, clear concepts, and standardized operating procedures. We should not blindly follow, nor should we confuse concepts and surgical names. This is an important prerequisite for the orderly development of minimally invasive surgery. NOSES emphasizes the removal of specimens through natural orifice, while NOTES mainly emphasizes the use of natural orifice as a surgical approach into the body cavity. TaTME emphasizes the trans-anal approach. NOSES and NOTES are two wide surgical concepts that apply to a variety of tissues and organs, while TaTME is a narrow surgical concept that is confined to the rectum. The main purpose of the three is to demonstrate a good minimally invasive effect on the basis of ensuring effective treatment of the disease. From the current technical conditions, no surgical technique is perfect. Only by selecting the best surgical method according to the patient′s condition , can the advantages of minimally invasive technology be maximized, and patients can benefit the most.