Objective: Traditional open discectomy has long been the standard treatment for lumbar disc herniation, but minimally invasive endoscopic approaches are increasingly being adopted. However, comprehensive comparative analyses of these techniques in terms of clinical outcomes remain limited. This study aimed to compare the short-term clinical outcomes of endoscopic versus open single-level lumbar discectomy, with the hypothesis that the endoscopic approach reduces postoperative complications within 1 month of surgery. Methods: This retrospective cohort study used data from the MARINER database, covering January 2017 to October 2022. Adult patients aged 18 to 74 years who underwent single-level lumbar discectomy were included. A total of 243,684 patients were identified (1,470 endoscopic and 242,214 open surgical procedures). A 1:3 propensity score matching was performed based on age, sex, Charlson Comorbidity Index, and selected comorbidities, yielding a balanced cohort of 5,640 patients (1,416 endoscopic; 4,224 open). Results: After matching, the demographic and comorbidity profiles of the 2 groups were well balanced. The endoscopic group demonstrated significantly lower rates of surgical site infections (0.35% vs. 0.95%, p<0.05; odds ratio [OR], 2.69; 95% confidence interval [CI], 1.06–6.85), surgical complications (0.71% vs. 1.52%, p<0.05; OR, 2.16; 95% CI, 1.11–4.17), and 30-day readmissions (2.47% vs. 7.65%, p<0.05; OR, 3.09; 95% CI, 2.19–4.36). Kaplan-Meier survival analysis over 18 months revealed no significant difference in the probability of subsequent lumbar fusion between groups (log-rank test p=0.8). Conclusion Endoscopic single-level lumbar discectomy is associated with fewer short-term complications compared with open surgery. These findings support the consideration of endoscopic techniques as a lower-risk alternative for appropriately selected patients. Further studies are needed to evaluate long-term outcomes.

Methods: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates. Results: A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p<0.001) and reoperation (0.1% vs. 0.6%, p=0.004). No significant differences in the rates of postdischarge complications were found between the matched groups. Conclusions Patients with worsened preoperative status, preoperative diagnosis of spondylolisthesis, and prolonged operative time are more likely to require prolonged hospitalization and blood transfusions and undergo unplanned reoperation. To reduce the risk of prolonged hospitalization and associated complications, patients indicated for TLIF should be carefully selected.

Transanal minimally invasive surgery (TAMIS) is a novel minimally invasive procedure which is performed by normal laparoscopic instruments through the single port transanally. Three kinds of procedures have been performed based on the TAMIS platform by now, including TAMIS-TME(total mesorectal excision), TAMIS-APE(Abdominoperineal excision) and TAMIS-Hartmann. Transanal total mesorectal excision (taTME) with dissection from bottom to up through the platform of TAMIS is also called TAMIS-TME. The greatest advantage of TAMIS-TME is that it increases the quality of specimen and decrease the adverse injury due to the sufficient vision of lower part of mesorectum in the operation. TAMIS-APE and TAMIS-Hartmann procedures emerge after the experience of TAMIS-TME. TAMIS-APE procedure not only firstly make the dissection of perineal phase minimally invasive, but also make the perineal vision more clear, the resection of levator ani muscle more precise, eventually the tailored APE procedure comes true under the laparoscopy of perineal phase. The dissection of mid-low mesorectum for recurrent tumor is usually difficult just from above, TAMIS facilitates the resection through entering the normal anatomical space under the tumor. If the tumor has the risk of recurrence, distal rectum is closed and proximal colostomy is made, we firstly performed this procedure and name it TAMIS-Hartmann. Therefore, TAMIS is not only a platform for taTME, but also it provides a transanal approach and a "button to up" conception for the mid-low rectal tumor.

Transanal minimally invasive surgery﹙TAMIS) is a novel minimally invasive procedure which is performed by normal laparoscopic instruments through the single port transanally. Three kinds of procedures have been performed based on the TAMIS platform by now, including TAMIS-TME ﹙total mesorectal excision), TAMIS-APE ﹙Abdominoperineal excision) and TAMIS-Hartman. Transanal total mesorectal excision ﹙taTME) with dissection from bottom to up through the platform of TAMIS is also called TAMIS-TME. The greatest advantage of TAMIS-TME is that it increases the quality of specimen and decrease the adverse injury due to the sufficient vision of lower part of mesorectum in the operation. TAMIS-APE and TAMIS-Harman procedures emerge after the experience of TAMIS-TME. TAMIS-APE procedure not only firstly make the dissection of perineal phase minimally invasive, but also make the perineal vision more clear, the resection of levator ani muscle more precise, eventually the tailored APE procedure comes true under the laparoscopy of perineal phase. The dissection of mid-low mesorectum for recurrent tumor is usually difficult just from above, TAMIS facilitates the resection through entering the normal anatomical space under the tumor. If the tumor has the risk of recurrence, distal rectum is closed and proximal colostomy is made, we firstly performed this procedure and name it TAMIS-Harman. Therefore, TAMIS is not only a platform for taTME, but also it provides a transanal approach and a “button to up” conception for the mid-low rectal tumor.

Transanal minimally invasive surgery﹙TAMIS) is a novel minimally invasive procedure which is performed by normal laparoscopic instruments through the single port transanally. Three kinds of procedures have been performed based on the TAMIS platform by now, including TAMIS-TME ﹙total mesorectal excision), TAMIS-APE ﹙Abdominoperineal excision) and TAMIS-Hartman. Transanal total mesorectal excision ﹙taTME) with dissection from bottom to up through the platform of TAMIS is also called TAMIS-TME. The greatest advantage of TAMIS-TME is that it increases the quality of specimen and decrease the adverse injury due to the sufficient vision of lower part of mesorectum in the operation. TAMIS-APE and TAMIS-Harman procedures emerge after the experience of TAMIS-TME. TAMIS-APE procedure not only firstly make the dissection of perineal phase minimally invasive, but also make the perineal vision more clear, the resection of levator ani muscle more precise, eventually the tailored APE procedure comes true under the laparoscopy of perineal phase. The dissection of mid-low mesorectum for recurrent tumor is usually difficult just from above, TAMIS facilitates the resection through entering the normal anatomical space under the tumor. If the tumor has the risk of recurrence, distal rectum is closed and proximal colostomy is made, we firstly performed this procedure and name it TAMIS-Harman. Therefore, TAMIS is not only a platform for taTME, but also it provides a transanal approach and a “button to up” conception for the mid-low rectal tumor.