TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series

Abstract

Background The purpose of this study is to demonstrate the feasibility of an innovative technique for the surgical management of rectal cancer: trans anal minimally invasive surgery assisted low anterior resection with total mesorectal excision (TAMIS assisted LAR TME) in a cadaver model. Trans anal endoscopic low anterior resection via natural orifice translumenal endoscopic surgery (NOTES) has been reported in cadaveric series using rigid trans anal endoscopic platforms. This procedure has not been described using a combination of a single incision laparoscopy and TAMIS soft trans anal endoscopic platform. Herein, we describe the first cadaveric series of TAMIS assisted single incision laparoscopic LAR with TME. Methods TAMIS assisted laparoscopic single incision LAR with TME was successfully performed in 5 fresh male human cadavers. The procedure was performed using the mini-Gelpoint single incision platform and the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA). The variables recorded were age, body mass index (BMI in kg/m2), operative time, complications, and specimen length. The grade of the TME was determined by evaluation of the specimen by photo documentation by a gastrointestinal pathologist. Results All cadavers were male with a mean age of 71 +/− 8 years and mean BMI of 28 +/− 3 kg/m2. The mean operative time was 200 +/− 55 minutes (range 128 – 249 min). The quality of the TME was Grade I (complete) with intact mesorectum in all five cases. The mean specimen length was 36.8 +/− 3.4 cm. Intra-operative complications included one bowel injury and one splenic capsular tear. Conclusions TAMIS assisted laparoscopic LAR with TME is feasible in this pre-clinical cadaveric series. We have also demonstrated that a high quality TME can be achieved with this technique. Trans anal endoscopic techniques employed to perform total mesorectal dissection may revolutionize the surgical management of rectal cancer. However, phase II clinical trials are needed to further evaluate the oncologic safety and surgical outcomes of trans anal endoscopic TME using various platforms prior to widespread application of this new technique.

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

“…4 Our technique is adequate, with a total TAMIS completion rate of 100% for lesions that averaged 7 cm from the anal verge, a positive margin rate of only 8% (4 of 50), morbidity rate of 16% and an average LOS of 1.1 day. Our outcomes were comparable or better than those of other published series in recent years [7][8][9][10]17,18,[20][21][22] (Table 4). The TAMIS technique is efficient, viable and safe for the treatment of rectal lesions.…”

“…Currently, there is no guideline available. 18 We recommend follow-up every 3-6 months with FSIG for about 2-3 years.…”

Initial experience of transanal total mesorectal excision with rigid or flexible transanal platforms in cadavers

“…Whiteford et al [4] described the use of exclusively transanal NOTES sigmoidectomy in three human cadavers, using existing transanal endoscopic microsurgery (TEM) equipment. Since then, there have been extensive cadaveric and animal studies demonstrating the feasibility and safety of taTME with or without laparoscopic assistance [5][6][7][8][9][10][11][12][13][14][15][16]. In 2010, the first clinical case of a hybrid taTME for rectal cancer was reported by Sylla et al [17]; since then, taTME has been performed in over 16 clinical series involving at least 150 patients.…”

Transanal total mesorectal excision (taTME) for rectal cancer: a training pathway

“…A new term, transanal minimally invasive surgery (TAMIS) [27], was coined by the group, and the technique has gained widespread interest in the field of colorectal surgery at the national and international level. Many of the disadvantages of the rigid transanal endoscopic platforms have been overcome by the development of soft, disposable transanal endoscopic platforms with the largest taTME experience and series published to date by Antonio Lacy, Barcelona, Spain [27][28][29][30][31][32][33][34][35][36].…”