Transanal Minimally Invasive Surgery (TAMIS): a clinical spotlight review

Abstract

Teresa deBeche-Adams, Imran Hassan, and the SAGES Guidelines Committee PreambleThe following clinical spotlight review regarding Transanal Minimally Invasive Surgery (TAMIS) is intended for physicians who manage and treat rectal pathology. It is meant to critically review this technique and the available evidence supporting its safety and efficacy. Based on the level of evidence, recommendations may or may not be given for its use in clinical practice. DisclaimerGuidelines for clinical practice and spotlight reviews are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. Spotlight reviews are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to convey recommendations based on a focused topic; within the defined scope of the review, they indicate the preferable, but not necessarily the only acceptable approaches due to the complexity of the healthcare environment. Guidelines and recommendations are intended to be flexible. Given the wide range of specifics in any healthcare problem, the surgeon must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines, spotlight reviews, and recommendations are developed under the auspices of the Society of American Gastrointestinal Endoscopic Surgeons and its various committees, and approved by the Board of Governors. Each clinical spotlight review has been systematically researched, reviewed and revised by the guidelines committee, and, when appropriate, reviewed by an appropriate multidisciplinary team. The recommendations are therefore considered valid at the time of production based on the data available. Literature reviewA systematic literature search was performed using PubMed for Transanal Minimally Invasive Surgery (TAMIS). The literature was reviewed from September 1, 2010 through May 31, 2016. Both the quality of the evidence and the strength of the recommendation for each of the guidelines were assessed according to the GRADE system. This uses a 4-tiered system for denoting the quality of evidence (very low (+), low (+ +), moderate (+ + +), or high (+ + + +)) and a 2-tiered system for strength of recommendation (weak, or strong).

Robotic transanal surgery: perspectives for application

“…Notably, the pneumorectum is achieved using common laparoscopic systems inflating CO 2 , and the endoluminal pressure ranges between 15 and 25 mmHg [1] . A 30°-or 45°-angled 5-mm laparoscope is preferable [12,13] , whereas conventional laparoscopic instruments are used for manipulation. Initially, singlesite multichannel ports conceived for laparoscopic abdominal surgery were adapted to a transanal use.…”

“…Initially, singlesite multichannel ports conceived for laparoscopic abdominal surgery were adapted to a transanal use. Later, several devices were specifically designed [12][13][14] .…”

TAMIS repair of a rectal stenosis not treatable by endoscopy

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Since the description of transanal endoscopic microsurgery (TEM) by Buess [1] and the later appraisal of transanal endoscopic operation(TEO) and tranasnal minimally invasive surgery (TAMIS) [2], these approaches have been used for the treatment of rectal neoplasms such as benign or early stage rectal cancer [3,4].Moreover, the transanal approach continues to evolve, and new indications are emerging, such as the removal of foreign bodies and repair of rectourethral fistula [4].In this video, we present our experience with the TAMIS approach for the treatment of a rectal stenosis non-suitable for endoscopic dilatation.A 48-year-old woman had a history of rectal stenosis and pelvic sepsis after transanal resection of a large polyp with high-grade dysplasia located in the mid rectum. Due to this process, a diverting colostomy was fashioned, drainage of the perirectal abscess was performed and a loose seton was placed.After failure of conservative management, we decided to proceed with a TAMIS approach to the rectal stenosis.

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“…Moreover, the transanal approach continues to evolve, and new indications are emerging, such as the removal of foreign bodies and repair of rectourethral fistula [4].…”

“…Since the description of transanal endoscopic microsurgery (TEM) by Buess [1] and the later appraisal of transanal endoscopic operation(TEO) and tranasnal minimally invasive surgery (TAMIS) [2], these approaches have been used for the treatment of rectal neoplasms such as benign or early stage rectal cancer [3,4].…”