Transanal minimally invasive surgery using laparoscopic instruments of the rectum: A review

Table 1 Operative outcomes and pathologic results of transanal minimally invasive surgery case reports and retrospective studies

Ref.	Pts, n (%)	LOS (day)	Size (cm)	location from the AV (cm)	Pathology											R0 (%)	SF, n (%)	CR (%)
					AD	NET	AC	pCR	T0	Tis	T1	T2	T3	GIST	Other
Atallah et al[13], 2010	6	5/6	3	9	3	1	2	0	0	1	1	0	0	0		83.3	0	100
Van den Boezem et al[55], 2011	12	1	3.5	7	9	0	3	0	0	0	1	2	0	0		100	0	75.0
Hompes et al[56], 2012	14	0.7 (0-5)	3.4	5	6	1	6	0	0	0	3	1	2	0	Residual rectal fold (1)	85.7	-	85.7
Lim et al[26], 2012	16	3 (2-6)	0.5 (0-1.5)	7.5 (4-10)	0	4	11	5	0	1	3	1	1	0	Mucocele (1)	100	-	100
Barendse et al[57], 2012	15	2.5	3.6	6	7	1	4	0	0	0	1	3	0	0	Fibrosis (1)	92.3	-	-
Alessandro et al[58], 2012	8	1	-	6.5	5	0	3	0	0	0	1	2	0	0		100	0	-
Ragupathi et al[59], 2012	20	1.1	3.0	10.6	14	6	1	0	0	0	0	1	0	0		95.0	-	95
Canda et al[60], 2012	6	-	4.75	7.2	5	0	1	0	0	1	0	0	0	0		100	0	83.3
Albert et al[30], 2013	50	0.6 (0-6)	2.75	8.2	23	2	23	0	0	1	16	3	3	0	HP (2)	94.0	2	98
Sevá-Pereira et al[61], 2014	5	1	4 (2-6)	4 (1-6)	2	0	4	0	0	2	0	1	0	0		100	0	60
McLemore et al[27], 2014	32	2.5 (1-10)	3 (0.5-7.5)	4.1 (1-11)	10	2	11	0	0	1	6	4	0	0	NRT (9)	100	-	90.6
Schiphorst et al[53], 2014	37	1 (1-23)	4.2	7	23	0	12	0	0	6	4	1	1	0	NRT (1)	78.4	0	100
Lee and Lee[28], 2014	25	4 (3-8)	2.3 (0.6-6)	9 (6-17)	6	9	9	0	0	0	0	0	0	1	NRT (6)	100	0	80
Hahnloser et al[33], 2015	75	3.4 (1-21)	4	6.4	35	1	38	3	4	11	13	9	1	0	Hamartoma (1); NRT (4)	96.0	6	-
Karakayali et al[51], 2015	10	0	2.6 (0.4-5)	5.6 (3-10)	1	0	9	0	0	5	4	0	0	0		100	0	50
Gill et al[62], 2015	32	1.1 (0-4)	2.1 (0.3-5)	7.5 (2-13)	11	4	15	0	0	0	0	0	0	0	Hamartoma (1); HP (1); NRT (10)	100	0	78.1
Noura et al[49], 2016	6	7 (6-8)	2.4 (1.5-3.0)	4.3 (3-6)	0	0	6	0	0	0	5	1	0	0		100	-	-
Quaresima et al[63], 2016	31	3 (2-7)	2.4 (1-5)	9.5 (6-15)	10	2	17	0	0	0	17	0	0	2		96.8	-	-
Keller et al[35], 2016	75	1 (0-6)	3.2	10 (6-16)	59	0	17	0	6	0	6	4	1	0		93.3	1	85.3
Sumrien et al[43], 2016	28	1.5 (0-4)	4.4 (1.2-11.5)	-	17	0	11	0	0	0	0	0	0	0		75.0	5	-
Verseveld et al[52], 2016	24	1 (1-3)	2.4	8 (2-17)	20	0	4	0	0	0	4	0	0	0		-	-	-
Melin et al[64], 2016	29	-	3.9	6.79	23	0	6	0	0	0	3	0	0	0		89.7	-	-
Mege et al[65], 2017	33	4 (1-60)	4 (1-10)	9 (0-12)	24	0	9	0	1	0	0	0	0	0	NRT (1)	78.8	-	-
Lee et al[24], 2018	200	1	2.9	7.2 (2-17)	85	10	100	3	11	25	41	10	10	0	NRT (11)	93.0	9	94.5
García-Flórez et al[66], 2017	32	-	3.4	5.6 (4-10)	15	1	12	0	0	0	4	4	4	1	Pelvic abscess (1)	96.9	2	84.4
Caycedo-Marulanda et al[44], 2017	50	1.1	2.5 (1-4.9)	7 (2-15)	23	1	16	0	0	0	0	0	0	0	Lipoma (1)	84.0	4	72.0
Clermonts et al[67], 2017	42	1 (1-24)	4.3	7.5 (0-19)	26	0	16	0	0	5	10	1	0	0		90.5	0	-
Lee et al[42], 2017	181	0	2.8	6.1	75	8	96	0	0	0	0	0	0	0	2	92.8	9	73.5
Lee et al[68], 2017	35	4 (3-7)	-	5 (4-9)	0	0	35	18	0	2	4	9	2	0		97.1	-	-
Chen et al[69], 2018	25	2.7	1.1	8.4	3	16	6	0	0	0	5	0	1	0		80.0	-	-
Clermonts et al[48], 2018	37	1 (1-5)	4.8	6.5 (0-19)	23	0	14	0	0	5	8	1	0	0		89.2	0	-
Dufresne et al[70], 2018	5	-	-	11 (8-14)	2	1	2	0	0	0	2	0	0	0		80.0	-	-
Llano et al[71], 2019	27	1.1	5.3 (2-9)	7 (5-9)	14	5	6	0	0	6	0	0	0	0	Cicatrical fibrosis (1); Leiomyoma (1)	1	2	-
Westrich et al[72], 2019	38	3 (1-7)	4 (1.5-9.0)	8 (5-12)	19	2	11	0	0	1	8	1	1	0	Granulation (8)	4	4	89.5
Van den Eynde et al[73], 2019	68	2 (1-3)	4.5	6 (5-10)	44	0	24	0	6	0	12	6	0	0		8	2	-
Lee et al[17], 2019	21	0.4	4.1	7.8	15	1	4	0	1	0	1	2	0	1		2	-	-
Abutaka et al[74], 2020	17	1.5 (1-6)	2.62 (1.2-7)	7.5 (3-18)	6	3	11	0	6	0	1	4	0	0	HP (1); IP(1)	100	1	64.7
Kang et al[45], 2020	30	4.3	1.6 (0.3-7.1)	7	5	18	4	0	0	0	0	0	0	0	Rectal stenosis (1), Rectal sinus (1), Anastomosis site dehiscence (1)	1	-	-
Goldenshluger et al[50], 2020	23	2.65	4.07	7.4	10	1	6	0	0	1	5	0	0	0	Granulation (6)	-	-	82.6

LOS: Length of stay; AV: Anal verge; AD: Adenoma; NET: Neuroendocrine tumor; AC: Adenocarcinoma; pCR: Pathologic complete response; GIST: Gastrointestinal stromal tumor; R0: R0 resection; SF: Specimen fragmentation; CR: Concordance rate of pathologic diagnosis between preoperative and postoperative results; HP: Hyperplastic polyp; NRT: No residual tumor; IP: Inflammatory polyp.

Table 2 Recurrence characteristics

Ref.	Pts, n (%)	No. of recurrence	Pathology	RM status	Risk factor	Time to recurrence (months)	Type	Treatment
Hompes et al[56], 2012	14	1	TVA	+	Absence	6	L	Refuse treatment
Ragupathi et al[59], 2012	20	1	VA	-	Absence	7	L	Re-TAMIS
Albert et al[30], 2013	50	1	VA	+	Absence	18	L	Re-TAMIS
		1	T1 sm3 adenocarcinoma	-	LVI, DI	6	L	Re-TAMIS
Schiphorst et al[53], 2014	37	1	Tis	-	Absence	9	L	Re-TAMIS
		1	Adenoma	+	Absence	8	L	Re-TAMIS
Gill et al[62], 2015	32	2	FAP; sigmoid colon cancer	ND	Absence	NA	Non-local recurrent disease	NA
Quaresima et al[63], 2016	31	1	Adenoma	+	Absence	18	L	Colonoscopic resection
Keller et al[35], 2016	75	1	T1 adenocarcinoma	-	DI	9	L	APR
		3	Adenoma	-	NA	NA	L	Re-TAMIS
		1	Adenoma	-	NA	NA	L	Closed surveillance
Sumrien et al[43], 2016	28	1	Adenoma	-	NA	NA	L	Endoscopic snaring
		1	Rectal cancer	NA	NA	NA	L	NA
		1	Rectal cancer	NA	NA	11	L	Palliative radiotherapy
		1	Unresectable rectal cancer	+	Palliative debulking	NA	L	Required further endoscopic resection
Melin et al[64], 2016	29	1	Adenoma	+	Absence	NA	L	Re-TAMIS
		1	T1 adenocarcinoma	-	DI	10	L	APR, neoadjuvant CRT
Mege et al[65], 2017	33	1	Rectal cancer	NA	NA	NA	NA	NA
Lee et al[24], 2018	200	1	TVA	+	Absence	17.6	L	Re-TAMIS (index operation)
		2	Adenoma	+	Absence	NA	L	Re-TAMIS
		1	Tis carcinoma in situ	-	Absence	15		Re-TAMIS
		1	Tis carcinoma in situ	-	Absence	11		Re-TAMIS
		1	T1 adenocarcinoma	-	Absence	17.5	L, D (lung)	Re-TAMIS, chemoradiation
		1	T1 adenocarcinoma	-	PD	6.8	D (lung)	Chemotherapy
		1	T2 adenocarcinoma	-	DI	10.8		Definitive chemoradiation
		1	T2 adenocarcinoma	-	DI	28.9		Robotic LAR
		1	T3 adenocarcinoma	-	DI	2.1	D (lung)	Refuse treatment
		1	T2 adenocarcinoma	-	DI	12	L, D	Refuse treatment
García-Flórez et al[66], 2017	32	1	T3 adenocarcinoma	-	DI	12	L	Radical surgery
		1	T2 adenocarcinoma	-	DI	8	L	Radical surgery
		1	Adenoma	-	NA	NA	L	NA
Caycedo-Marulanda et al[44], 2017	50	1	Adenoma	NA	NA	13	L	Re-TAMIS
		1	NA	NA	NA	35	L (presacral mass), D (multiple liver)	Palliative chemotherapy
		1	T2 adenocarcinoma	+	DI	16	L	Re-TAMIS, palliative chemotherapy
		1	T2 adenocarcinoma	NA	DI	NA	L	APR
Clermonts et al[67], 2017	42	1	T1 adenocarcinoma	-	NA	9	L	Re-TAMIS
Lee et al[68], 2017	35	1	T1 adenocarcinoma	NA	NA	3	L (TAMIS site)	Hartmann`s operation
		1	T2 adenocarcinoma	NA	DI	40	L (perirectal LN)	Mass excision, chemotherapy
		1	T2 adenocarcinoma	NA	DI	16	L (perirectal LN), D (liver)	Chemotherapy
		1	T2 adenocarcinoma	NA	DI	37	D (lung)	Chemotherapy
		1	T0 adenocarcinoma	NA	NA	4	D (lung)	Wedge resection, chemotherapy
Westrich et al[72], 2019	38	4	Adenoma			26	L	re-TAMIS
		1	T1 adenocarcinoma	Closed RM (1 mm)	NA	9	L	APR
		1	T1 adenocarcinoma	-	PNI	24	L, D	Adjuvant radiotherapy, chemotherapy
		1	T3 adenocarcinoma	-	DI	10	L	Adjuvant radiotherapy
		2	NA	NA	NA	NA	D

RM: Resection margin; TVA: Tubulovillous adenoma; VA: Villous adenoma; FAP: Familial adenomatous polyposis; LVI: Lymphovascular invasion; TAMIS: Transanal minimally invasive surgery; PD: Poorly differentiated adenocarcinoma; DI: Deep invasion; APR: Abdominoperineal resection; CRT: Chemoradiotherapy; PNI: Perineural invasion; L: Local recurrence; D: Distant metastasis; LN: Lymph node; NA: Not available.

Table 3 Postoperative Complications and it’s treatment

Ref.	Pts, n (%)	Complications, n (%)	Type of complications, n (%)	Reoperation	Re-admission	Conversion	Treatment of PPC
Van den Boezem et al[55], 2011	12	1	Bleeding (1)	0	0	TAE (2)	0
Hompes et al[32], 2014	14	2	Fever (1); Bleeding (1)	Positive for deep margin (1)	0	CAD fail (1); TEM assist (1)	0
Barendse et al[57], 2012	15	2	Pneumoscrotum (1); Hemorrhage (1)	0	Bleeding (1)	TEM (2)	0
Ragupathi et al[59], 2012	20	1	Abscess (1)	Inadequate surgical margin within 1mm (2)	0	0	0
Albert et al[30], 2013	50	4	Bleeding (1); Scrotal emphysema (1); PPC (1); COPD exacerbation (1)	0	Bleeding (1)	0	TAMIS repair (1)
Sevá-Pereira et al[61], 2014	5	1	Partial dehiscence of the suture line (1)		0	L-LAR (1)
McLemore et al[27], 2014	32	8	FI (3); UTI (1); CD diarrhea (1); Afib (1); Rectal stenosis (1); Bleeding (1)	0	Bleeding (1)	TAE (1)	0
Schiphorst et al[53], 2014	37	6	Rectal perforation (2); Heamorrhage (2); Abscess (1); Rectal stricture (1)	Pelvic abscess (1)	Bleeding (3); Pelvic abscess (1)	L-AR (1)	L-AR (1). Pelvic abscess drainage (1)
Lee and Lee[28], 2014	25	1	POUR (1)	0	0	0	0
Hahnloser et al[33], 2015	75	21	Local infection (6); Postoperative bleeding (5); Intraoperative bleeding (3); Penetrate peritoneal cavity (3); Pneumoscrotum (3); UTI (2); POUR (2)	Rectal perforation (1)	NA	TAMIS + LR (2), Open laparotomy (1)	TAMIS + LR (2), Open laparotomy (1)
Gill et al[62], 2015	32	16	Bleeding (4); Diarrhea (4); POUR (3); Perianal pain (2); Ulceration (4); Hypovolemia (1); Rectal abscess (1); Aspiration pneumonia (1); FI (1)	Rectal perforation (1)	Aspiration penumoia (1); Rectal abcess (1)	TEM (1)	0
Quaresima et al[63], 2016	31	8	Penetrate peritoneal cavity (5); UTI (1); Subcutaneous emphysema (1); Hemorrhoidal thrombosis (1)	0	0	TAE (4)	TAMIS repair (4); TAE (1)
Keller et al[35], 2016	75	3	Bleeding (1); Rectal stricture (1); Rectovaginal fistula (1)	0	Rectal bleeding (1)	TAMIS + LR (2), DS (1), Diagnostic laparoscopy (1)	TAMIS + LR (1); TAMIS + DS (1)
Sumrien et al[43], 2016	28	10	POUR (6); Bleeding (1); PPC (1); Stricture (1); Fever (1)	Bleeding (1)	Rectal bleeding (1)	L-AR (2), O-AR (1), Endoscopic debulking (1)	TAMIS repair (1)
Verseveld et al[52], 2016	24	2	Bleeding (2)	Re-bleeding (1)	1	0	NA
Melin et al[64], 2016	29	3	Bleeding (1); POUR (1); PPC (1)	Bleeding (1), Resudual rectal polyp (1)	0	0	TAMIS repair (1)
Mege et al[65], 2017	33	4	NA	NA	NA	NA	2
Lee et al[24], 2018	200	31	Intraoperative complications (8); Bleeding (9); POUR (4); Scrotal or subcutaneous emphysema (3) Mild fecal incontinence (2); Self-limiting fever (2); Perianal pain (2); Perirectal inflammation (1); DVT (1); Heparin-induced thrombocytopenia (1); Rectovaginal fistula (1); UTI (1); Non-healing rectal wound (1)	DS for nonhealing wound (1)	Nonhealing rectal wound (1); Perirectal inflammation (1), Rectovaginal fistula (1)	TAMIS + LR (4)	TAMIS repair (4); TAMIS + LR (4)
García-Flórez et al[66], 2017	32	13	Fever (3); Hematuria (3); Rectal bleeding (3); PPC (2); Purulent peritonitis (1); Stenosis (1)	1	1	0	Transanal repair (2)
Caycedo-Marulanda et al[44], 2017	50	13	Bleeding (4); UTI (1); Suture line leak (1); POUR (1); PPC (5); Anal structure (1)	Penetrate peritoneal cavity (1)	Bleeding (4)	Hybrid (3)	Transanal repair (5)
Clermonts et al[67], 2017	42	6	Hemorrhage (4); Abscess (1); Rectal stricture (1)	Pelvic abscess (1)	4	0	0
Lee et al[42], 2017	181	16	Bleeding (4); Local infection (6); POUR (2); Complication requiring operation (2)	2	NA	LR (2); DS (1)	TAMIS repair (4), LR (2)
Lee et al[68], 2017	35	1	Suture line dehiscence (1)	0	0	0	0
Clermonts et al[67], 2017	37	4	Bleeding (3); Abscess (1)	Pelvic abscess (1)	4	0	0
Llano et al[71], 2019	27	6	PPC (2); Rectal bleeding (1); POUR (1); Advanced cancer (1); Stenosis (1)	0	0	LR (1)	TAMIS repair (1); LR (1)
Westrich et al[72], 2019	38	8	Fever (4); Bleeding (2); PPC (1); Major complication (1)	Rectal perforation (1)	Rectal perforation (2), bleeding (2)	0	TAMIS repair (1)
Van den Eynde et al[73], 2019	68	19	Bleeding (1); Complications ≥ grade 3 (1)	Bleeding (5)	3	NA	NA
Lee et al[17], 2019	21	2	POUR (1); PPC (1)	0	0	LR (1)	LR (1)
Abutaka et al[74], 2020	17	3	Bleeding (1); PPC (2)	0	0	LR (1)	TAMIS repair (1); LR (1)
Kang et al[45], 2020	30	4	Diarrhea (2); FI (1); Fluid collection (1)	0	0	TAE (2)	0
Goldenshluger et al[50], 2020	23	3	Bleeding (1); Fever (1)	0	0	0	0

TAMIS: Transanal minimally invasive surgery; Afib: Atrial fibrillation; FI:Fecal incontinence; UTI: Urinary tract infection; DVT: Deep vein thrombosis; CD: Clostrium difficle; COPD: Chronic obstructive pulmonary disease; POUR: Postoperative urinary retention; PPC: Penetrate peritoneal cavity; -: Not available; LR: Laparoscopic repair; DS: Diverting stoma; TAE: Conventional transanal excision; L-AR: Laparoscopic anterior resection; O-AR: Open anterior resection.