Transanal minimally invasive surgery (TAMIS) using a new disposable device: our initial experience

Abstract

Disposable single-port surgery devices have been used for transanal minimally invasive surgery (TAMIS). Their advantage, compared to transanal endoscopic microsurgery, is that they do not require special equipment or training. The aim of this study was to assess our initial experience using the single-site laparoscopic (SSL™) access system (Ethicon Endo-Surgery, Cincinnati, OH, USA) for TAMIS. Five patients eligible for local excision of rectal tumors, four males and one female, mean age 58 years (range 50-78), underwent surgery using the SSL™ device. The average distance from anal verge was 4 cm (range 1-6). Four patients had an initial diagnosis of adenoma, and one had a previous endoscopic excision of a T1 adenocarcinoma with positive margins. In one patient, due to the lack of exposure, the procedure was converted to a low anterior resection. In the remaining four patients, average setup time was 7 minutes (range 4-15) and average operative time was 52 minutes (range 38-72). All resection margins were tumor free. There were no postoperative complications. Two of the presumed adenomas were intramucosal adenocarcinomas, while one patient had a T2 tumor and underwent radical surgery. Although at the present time the appropriate use of local excision is still under debate, TAMIS is a technique with great potential. Because of its simplicity and similarity with conventional laparoscopic surgery, it can be learned easily by surgeons not trained in transanal endoscopic microsurgery.

Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors

“…Iatrogenic peritoneal entry during excision with TAMIS was reported for one patient, but it was also treated transanally without open surgery. [ 27 29 ] In this study, all 10 excisions had no perioperative or postoperative complications.…”

Resección de tumoración rectal mediante cirugía transanal mínimamente invasiva (TAMIS)

“…2 Las indicaciones para TAMIS son las mismas que para TEM, 3 pero se han descrito algunas ventajas de la TAMIS con respecto a la TEM: 1) los dispositivos utilizados para TAMIS son flexibles y permiten un posicionamiento bien ajustado en el canal anal, por lo que afecta menos la función del esfínter que el endoscopio rígido de 40 mm utilizado para TEM; 2,12 2) el tiempo de configuración es significativamente menor para TAMIS; 3) en la TAMIS los instrumentos laparoscópicos son no angulados y se emplea un lente estándar de 30° laparoscópico, en comparación con el ocular fijo del rectoscopio dela TEM; 4) la TAMIS la aprenden fácilmente los cirujanos que no utilizan TEM, debido a su simplicidad en el instrumental y similitud con la cirugía laparoscópica convencional; 13 5) los dispositivos de TAMIS son más baratos que el equipo de TEM, aunque no son reutilizables, como los delaTEM. 12 Además, con la TAMIS se han desarrollado algunos otros procedimientos, como la resección transanal de mesorrecto en resecciones anteriores bajas muy difíciles, especialmente en pacientes masculinos y obesos. 3,14 En el mercado existen varios dispositivos de puerto único multicanal para TAMIS: el puerto SILSTM (Covidien, Mansfield, MA), el puerto SSLTM (Ethicon, Cincinnati, OH), y el GelPOINTPath (Applied Medical, Rancho Santa Margarita, CA.…”

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

“…Repeat TAMIS is also an option for patients with T1 disease and a positive margin microscopically. Some patients may opt for treatment with adjuvant radiotherapy[52]. There is no consensus about the timing of the radical surgery and role of adjuvant radiotherapy in this setting[53].…”