Transanal minimal invasive surgery (TAMIS): safety and feasibility for the resection of benign and malignant lesions of the rectum

Abstract

Objective: Radical surgery for rectal tumours has high morbidity. Local excision of such tumours can be achieved without compromising oncologic safety. However tumours that are not accessible to local excision can be approached using Transanal Minimal Invasive Surgery (TAMIS). The aim of our study was to assess feasibility of TAMIS procedure in terms of complications, operating time, resection margin positivity, hospital stay and local recurrence rate. Material and Methods: Forty eight patients with benign adenomas or early stage adenocarcinoma, within 4 to 12 cm from anal verge who were subjected to TAMIS over a period of 3 years were included in the study. Short and long term outcomes were assessed. Results: TAMIS was performed for 36 benign adenomas and 12 adenocarcinomas, which were located at an average distance of 6.2 cm from anal verge. The mean operating time was 72 minutes. There were no intraoperative complications.1 (2.08%) patient suffered post operative bleeding, which was managed conservatively. 2 (4.16%) patients developed acute urinary retention who required indwelling catheterisation. Resection margin was positive in 3 (6.25%) benign cases. Average hospital stay was 2.7 days. Local recurrence occurred in 2 (4.16%) villous adenoma patients (after 11 and 13 months), whereas in malignant patients there was no recurrence at a follow up period ranging between 12 to 36 months. Conclusion: TAMIS is a safe and feasible procedure for benign tumours and early rectal cancers, located in low and middle rectum.

Resección transanal de lesiones premalignas: experiencia y aplicación de la técnica de cirugía transanal mínimamente invasiva (TAMIS)

“…Las complicaciones del procedimiento se han reportado aproximadamente en un 7.4%, con una tasa de conversión de un 2.3%, mientras que en pólipos malignos los márgenes positivos se han reportado en un 4.4% y la perforación peritoneal en un 1% 4 .…”

Clinical Robotic Surgery Association (India Chapter) and Indian rectal cancer expert group’s practical consensus statements for surgical management of localized and locally advanced rectal cancer

“…Specifically, for India, the authors could find only one study from India, which had evaluated local excision in early-stage rectal cancer. This prospective study enrolled 36 benign rectal polyps and 12 malignant rectal cancer cases and didn’t report any local recurrence in malignant cases with a follow-up ranging from 1 to 3 years ( 39 ).…”

Current Surgical Methods in Local Rectal Excision

“…Usually, a 30- or 45-degree angled 5 mm laparoscope is used for better visualisation due to limited operating space. Another benefit of an angled laparoscope is that the patient’s position does not depend on the tumour’s location [ 46 ]. The use of the classical laparoscopic instrument is a significant benefit in TAMIS surgery since it does not require expensive equipment or devices used in TEM.…”