Transanal minimally-invasive surgery (TAMIS): Technique and results from an initial experience

Abstract

Transanal endoscopic microsurgery is a minimally-invasive approach for rectal lesions. Superior exposure and access to the entire rectum result in lesser risk of compromised margins and lower recurrence rates, when compared to conventional transanal excision. The aim of this study was to describe a single institution's initial experience with transanal minimally invasive surgery (TAMIS). This was a prospective review of our database. Eleven procedures from January 2012 to June 2013 were analyzed. Results eleven operations were completed. Five men were evaluated. Mean age was 62.9 (40-86). Mean follow-up was 9.3 (2-17) months. Average tumor size was 3.8 (1.8-8) cm. Mean distance from anal verge was 6.3 (3-12) cm. Mean operating time was 53.73 (28-118) min. Postoperative complication rate was 9.1%. There were no readmissions. Mortality was null. Operative pathology disclosed the presence of adenoma in four patients, invasive adenocarcinoma in two, neuroendocrine carcinoma in three, and no residual lesion in one case. TAMIS is a minimallyinvasive procedure with low postoperative morbidity at the initial experience. TAMIS is a curative procedure for benign lesions and for selected early cancers. It is useful after neoadjuvant therapy for strictly selected cancers, pending the results of multi-institutional trials.

Robotic transanal surgery: perspectives for application

“…Peritoneal entry represents a well-known complication of TAMIS and it is described more frequently when tumors are located anteriorly in the middle or upper rectum [12] . When it occurs (1% of cases [12] ), it is recommended to use a steep Trendelenburg position to facilitate wall repair and to convert to laparoscopy if it is impossible to maintain an adequate pneumorectum [22][23][24] . With this regard, some authors suggest placing the patients in a prone position to limit the amount of CO 2 passing into the peritoneal cavity [25] .…”

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

“…In this instance, converting to a laparoscopic assisted approach to aid in closure of the defect should not be delayed. 56,60,61 Some authors recommend placing patients in the prone position if peritoneal entry is likely, where the pressure on the abdomen limits the amount of insufflation that can traverse into the peritoneal cavity. 81 A Gastrografin enema can be considered prior to discharge to ensure that there is not a leak after repair.…”

“…TAMIS has now been successfully performed with a variety of ports including other commercially available single-site ports 60,63 and even a customized glove-port. 64 Internationally, the further ports available are the KeyPort Flex (Richard Wolf, Knittlingen, Germany), the SSL (Single-Site Laparoscopic access system, Ethicon Endo-Surgery, Cincinnati, OH), and the Endorec® (Aspide Médical, LaTalaudière, France).…”