Transanal Minimally Invasive Surgery for Rectal Lesions

Abstract

Background and Objectives:Transanal minimally invasive surgery (TAMIS) has emerged as an alternative to transanal endoscopic microsurgery (TEM). The authors report their experience with TAMIS for the treatment of mid and high rectal tumors.Methods:From November 2011 through May 2016, 31 patients (21 females, 68%), with a median age of 65 years who underwent single-port TAMIS were prospectively enrolled. Mean distance from the anal verge of the rectal tumors was 9.5 cm. Seventeen patients presented with T1 cancer, 10 with large adenoma, 2 with gastrointestinal stromal tumor (GIST) and 2 with carcinoid tumor. Data concerning demographics, operative procedure and pathologic results were analyzed.Results:TAMIS was successfully completed in all cases. In 4 (13%) TAMIS was converted to standard Park's transanal technique. Median postoperative stay was 3 days. The overall complication rate was 9.6%, including 1 urinary tract infection, 1 subcutaneous emphysema, and 1 hemorrhoidal thrombosis. TAMIS allowed an R0 resection in 96.8% of cases (30/31 cases) and a single case of local recurrence after a large adenoma resection was encountered.Conclusion:TAMIS is a safe technique, with a short learning curve for laparoscopic surgeons already proficient in single-port procedures, and provides effective oncological outcomes compared to other techniques.

Surgical and Postoperative Evaluations of Rectal Adenomas Ecised With a Novel Proctoscope.

“…In this series, the tumor extended up into the anterior wall of the upper rectum, similar to our study (15). Some authors described a 13% rate of conversion to Park's transanal technique (18), mainly due to the proximity of the anal border and the di culty in maintaining the pneumorectum (17). This did not occur in our study because there was no need for a pneumorectum in our proctoscope.…”

Gastrointestinal stromal tumor of the rectum resected by transanal total mesorectal excision after neoadjuvant imatinib treatment: A case report

“…Very few cases of rectal GISTs have been treated by trans-anal surgery. 2,3 TaTME is the latest advanced surgical technique for lower rectal cancer. The positioning for TaTME provides an adequate view of the operating field in the pelvic cavity, and allows for a precise full thickness resection of the tumor with preserving the mesorectum.…”

Robotic transanal microsurgery for high early rectal neoplasia (T0-T1, N0 lesions), case series of 10 patients

“…More time and clinical trials are required to determine if laparoscopic TAMIS can achieve the same oncologic outcomes. However, it has been rapidly adopted by many colorectal surgeons due to the use of technology that is already familiar and available . While the introduction of TEM and TAMIS improved the ability to perform LE for early rectal cancers, the use of TEM is still limited by equipment availability and laparoscopic TAMIS is still limited to lesions within 15 cm due to instrument length …”

“…However, it has been rapidly adopted by many colorectal surgeons due to the use of technology that is already familiar and available. 6,7 While the introduction of TEM and TAMIS improved the ability to perform LE for early rectal cancers, the use of TEM is still limited by equipment availability and laparoscopic TAMIS is still limited to lesions within 15 cm due to instrument length. 2 Robotic-TAMIS, first described by Attalah et al and Hompes et al 8,9 has been the natural progression of laparoscopic-TAMIS and…”