Implementation of transanal minimally invasive surgery (TAMIS) for rectal neoplasms: results from a single centre

Background Local excisions are important in a tailored approach to treatment of rectal neoplasms. In cases of low risk T1 local excision facilitates rectal-preserving treatment. Transanal minimally invasive surgery (TAMIS) is the most recent alternative developed for local excision. In this study we evaluate the results after implementing TAMIS as the routine procedure for local excision of rectal neoplasms. Methods All patients who underwent TAMIS from January 2016 to January 2020 at St. Olav’s University Hospital were included, and clinical, pathological and oncological data were prospectively registered. The primary endpoint was local recurrence, and the secondary endpoint was complications. Results There were 76 patients (42 men, mean age was 69 years [range 26–88 years]), The mean tumour level was 82 mm (range 20–140 mm) from the anal verge measured on rigid proctoscopy, and mean tumour size was 32 mm (range 8–73 mm). Three patients experienced complications needing intervention (Clavien–Dindo > 3A). Seventeen patients had rectal adenocarcinoma, 9 of whom underwent R0 completion total mesorectal excision (cTME). Fifty-five patients had an adenoma, 3 of whom developed recurrence (5.4%) within 12 months. All recurrences were treated successfully with a new TAMIS procedure. In addition, TAMIS was used in treatment of 2 patients with a neuroendocrine tumour, 1 patient with a haemangioma and 1 patient with a solitary rectal ulcer. Conclusions TAMIS surgery is associated with a low risk of complications and a low recurrence rate in rectal neoplasms. In cases of adenocarcinoma, R0 cTME surgery is feasible in the sub-group with high risk T1 and T2 tumours.

Transanal Minimally Invasive Surgery: A Useful Technique That Continues to Evolve

Colorectal cancer remains the 3rd most common cancer diagnosed among men and women in the United States. With improved screening, premalignant rectal lesions and rectal cancers are being detected at earlier stages. In addition, the use of neoadjuvant chemo- and radiotherapy has led to downstaging of larger lesions. There is growing interest among colorectal surgeons in local excision with organ preservation for patients with rectal cancer. There are multiple platforms for local excision of rectal cancers, including transanal excision (TAE), transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS). TAMIS was developed as an affordable platform that uses conventional laparoscopic equipment familiar to many colorectal surgeons. TAMIS allows for full-thickness benign or malignant lesion excision in any quadrant without the need for patient repositioning. The literature has shown that, for appropriately selected patients, TAMIS provides superior excision quality compared to TAE. Furthermore, TAMIS has oncologic outcomes equivalent to TEM at a fraction of the cost. Recently, robotic TAMIS has been introduced, which takes advantage of the articulating instruments of the robotic platform without the need for a skilled assistant. This article will cover multiple technical aspects for TAMIS including patient selection and preparation, technical tips for successful excision and defect closure, and recent advances, including robotic TAMIS.

The first robotic transanal minimally invasive surgery in Ireland: a case-based review

Transanal minimally invasive surgery (TAMIS) has gained worldwide acceptance as a means of local excision of early rectal cancers and benign rectal lesions. However, it is technically challenging due to the limitations of rigid laparoscopic instruments in the narrow rectal lumen. Robotic platforms offer improved ergonomics that are valuable in operative fields with limited space. Robotic TAMIS represents an exciting new development that may be more versatile than traditional TAMIS. In this review, we describe the first case of robotic TAMIS performed in our country and a review of current literature on the technique.