TAMIS for rectal tumors: advancements of a new approach

Abstract

TAMIS allows transanal excision of rectal lesions by the means of a single-incision access port and traditional laparoscopic instruments. This technique represents a promising treatment of rectal neoplasms since it guarantees precise dissection and reproducible approaches. From May 2010 to September 2015, we performed excisions of rectal lesions in 55 patients using a SILS port. The pre-operative diagnosis was 26 tumours, 26 low and high grade displasias and 3 other benign neoplasias. 11 patients had a neoadjuvant treatment. Pneumorectum was established at a pressure of 15-20 mmHg CO2 with continuous insufflation, and ordinary laparoscopic instruments were used to perform full thickness resection of rectal neoplasm with a conventional 5-mm 30° laparoscopic camera. The average operative time was 78 min. Postoperative recovery was uneventful in 53 cases: in one case a Hartmann procedure was necessary at two postoperative days due to an intraoperative intraperitoneal perforation; in another case, a diverting colostomy was required at the five postoperative days due to an intraoperative perforation of the vaginal wall. Unclear resection margins were detected in six patients: thereafter five patients underwent radical surgery; the other patient was unfit for radical surgery, but is actually alive and well. Patients were discharged after a median of 3 days. Transanal minimally invasive surgery is an advanced transanal platform that provides a safe and effective method for low rectal tumors. The feasibility of TAMIS also for malignant lesions treated in a neoadjuvant setting could be cautiously evaluated in the future.

Transanal endoscopic microsurgery as day surgery – a single‐centre experience with 500 patients

“…A survey of recent publications suggests that admission to hospital is still common, with most series reporting a minimum hospital stay of of 1 day (see Table ) . However, Laliberte et al .…”

“…A survey of recent publications suggests that admission to hospital is still common, with most series reporting a minimum hospital stay of of 1 day (see Table 4) [10][11][12][13][14]18,19]. However, Laliberte et al and Lee et al report outpatient surgery in 80% and 76% of their TEM/TAMIS patients, respectively [4,6].…”

“…While some studies have shown TES to be feasible as an outpatient procedure [6][7][8][9], the majority of published studies of TEM/TAMIS continue to show mean hospital stays of 1-5 days [10][11][12][13][14]. At SPH, we transitioned from an admission-predominant strategy to an outpatient approach early in our 10-year experience with the technique.…”

Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery

“…Listed in Table 2 are publications involving more than 15 patients diagnosed with early adenocarcinoma and subjected to TAMIS. These results revealed that the majority of patients have a successful operation, with operative time of about 80 min, length of stay in hospital is one day, positive resection margins is less that 10% and less than 10% of patients have complications[56-59]. The few studies looking at quality of life and functional outcomes reveal that overall quality of life was improved or not impaired after TAMIS, probably due to the removal of the tumor, and at 6 mo was equal to the general population[56,60].…”

Transanal minimally invasive surgery for local excision of early rectal tumor

“…Recently, new procedures, specifically transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), have been introduced to LE. TAMIS techniques involve lifting the healthy mucosa with a gentle grasp or the use of an end loop . Here, we present a TAMIS technique for LE to which ESD was applied.…”