|
1
|
Šemanjski K, Lužaić K, Brkić J. Current Surgical Methods in Local Rectal Excision. Gastrointest Tumors 2023; 10:44-56. [PMID: 39015761 PMCID: PMC11249472 DOI: 10.1159/000538958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/10/2024] [Indexed: 07/18/2024] Open
Abstract
Background The treatment of rectal cancer has evolved with the advancement of surgical techniques. Less invasive approaches are becoming more accepted as the primary treatment method. Summary Such methods as transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery can reduce morbidity and mortality rates. However, not all patients are suitable candidates for these procedures, and proper diagnostics are necessary to establish indications. Compared to total mesorectal excision, transanal excision techniques have been shown to have fewer complications and comorbidities while still being able to remove cancerous tissue entirely. Transanal excision is the simplest method, where the operator removes visible rectal lesions. The basic principle of transanal endoscopic microsurgery is to dilate the rectum mechanically and by air insufflation and then use special surgical instruments to remove suspicious lesions under the vision of a telescope. Transanal minimally invasive surgery combines transanal endoscopic microsurgery and single-incision laparoscopic surgery, making the hard-to-reach proximal rectum accessible to classic laparoscopic instruments. Key Message Local excision techniques, when used as a monotherapy for treating patients with rectal cancer, have established themselves as a curative and less radical treatment for strictly selected patients with early rectal carcinoma, leading to improved quality of life. When combined with other modalities such as neoadjuvant chemoradiotherapy, total neoadjuvant therapy, and immunotherapy, transanal surgery can be offered to patients with locally advanced rectal cancer as part of the organ preservation strategy. This review will discuss the patient selection and technical aspects of transanal surgery, showcasing its current role in treating rectal carcinoma.
Collapse
Affiliation(s)
| | - Karla Lužaić
- Institute of Emergency Medicine of Sisak - Moslavina County, Sisak, Croatia
| | - Jure Brkić
- Department of Surgery, Clinical Hospital Sveti Duh, Zagreb, Croatia
| |
Collapse
|
|
2
|
Muacevic A, Adler JR. A Review of Tubal Factors Affecting Fertility and its Management. Cureus 2022; 14:e30990. [PMID: 36475176 PMCID: PMC9717713 DOI: 10.7759/cureus.30990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023] Open
Abstract
Infertility is a problem that affects both developed and developing countries today. Many couples choose to have financial stability before conception, irrespective of age. Tubal blockage accounts for 30%-40% of a woman's fertility. Congenital abnormalities, acute and persistent inflammatory diseases, endometriosis, and different pathologies are associated with infertility and cause partial or complete obstruction of the fallopian tubes. Approximately 30% of women experience infertility due to fallopian tube illness, with 10%-25% of these women experiencing proximal fallopian tube obstruction. The fallopian tube is an integral part of the union of sperm, and its normal function is a prerequisite for natural conception. Tubal obstruction is a common cause of infertility. These patients are keen to unblock their blocked fallopian tubes and restore reproductive function. Accurate diagnosis and optimal treatment options are essential for treating infertility.
Collapse
|
|
3
|
Transanal minimally invasive surgery (TAMIS) for rectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
|
4
|
Berger NF, Sylla P. The Role of Transanal Endoscopic Surgery for Early Rectal Cancer. Clin Colon Rectal Surg 2022; 35:113-121. [PMID: 35237106 PMCID: PMC8885158 DOI: 10.1055/s-0041-1742111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Transanal endoscopic surgery (TES), which is performed through a variety of transanal endoluminal multitasking surgical platforms, was developed to facilitate endoscopic en bloc excision of rectal lesions as a minimally invasive alternative to radical proctectomy. Although the oncologic safety of TES in the treatment of malignant rectal tumors has been an area of vigorous controversy over the past two decades, TES is currently accepted as an oncologically safe approach for the treatment of carefully selected early and superficial rectal cancers. TES can also serve as both a diagnostic and potentially curative treatment of partially resected unsuspected malignant polyps. In this article, indications and contraindications for transanal endoscopic excision of early rectal cancer lesions are reviewed, as well as selection criteria for the most appropriate transanal excisional approach. Preoperative preparation and surgical technique for complications of TES will be reviewed, as well as recommended surveillance and management of upstaged tumors.
Collapse
Affiliation(s)
| | - Patricia Sylla
- Icahn School of Medicine at Mount Sinai, New York, New York,Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, New York,Address for correspondence Patricia Sylla, MD, FACS, FASCRS Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Hospital5 East 98th Street, Box 1259, New York, NY 10029
| |
Collapse
|
|
5
|
Endoscopic full-thickness dissection (EFTD) in the rectum: a case series. Tech Coloproctol 2021; 26:187-193. [PMID: 34964075 PMCID: PMC8857165 DOI: 10.1007/s10151-021-02558-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/29/2021] [Indexed: 01/13/2023]
Abstract
Abstract
Background
Rectal endoscopic full- thickness dissection (EFTD) using a flexible colonoscope is an alternative to the well-established trans-anal endoscopic microsurgery (TEM) and the trans-anal minimally invasive surgery (TAMIS) techniques for resecting dysplastic or malignant rectal lesions. This study evaluated EFTD safety by analyzing outcomes of the first patients to undergo rectal EFTD at the University Hospital of North-Norway.
Methods
The first 10 patients to undergo rectal EFTD at the University Hospital of North-Norway April, 2016 and January, 2021, were included in the study. The procedural indications for EFTD were therapeutic resection of non-lifting adenoma, T1 adenocarcinoma (AC), recurrent neuroendocrine tumor (NET) and re-excision of a T1-2 AC.
Results
EFTD rectal specimen histopathology revealed three ACs, five adenomas with high-grade dysplasia (HGD), one NET and one benign lesion. Six procedures had negative lateral and vertical resection margins and in three cases lateral margins could not be evaluated due to piece-meal dissection or heat damaged tissue. Two patients experienced delayed post-procedural hemorrhage, one of whom also presented with a concurrent post-procedural infection. No serious complications occurred.
Conclusion
Preliminary results from this introductory trial indicate that EFTD in the rectum can be conducted with satisfactory perioperative results and low risk of serious complications.
Collapse
|
|
6
|
Naiderman D, Tufare AL, Trinchero LB, Rossi F, Dolan M, Cano DM, Fagalde RL, Jury GL. Transanal Minimally-Invasive Surgery (TAMIS): Experience with No Closure of the Rectal Defect. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1055/s-0041-1735642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background In transanal minimally-invasive surgery (TAMIS), the closure of the rectal defect is controversial, and endoluminal suture is one of the most challenging aspects. The goal of the present study is to evaluate the short- and medium-term complications of a consecutive series of patients with extraperitoneal rectal injuries who underwent TAMIS without closure of the rectal defect.
Materials and Methods A prospective, longitudinal, descriptive study conducted between August 2013 and July 2019 in which all patients with extraperitoneal rectal lesions, who were operated on using the TAMIS technique, were consecutively included. The lesions were: benign lesions ≥ 3 cm; neuroendocrine tumors ≤ 2 cm; adenocarcinomas in stage T1N0; and adenocarcinomas in stage T2N0, with high surgical risk, or with the patients reluctant to undergo radical surgery, and others with doubts about complete remission after the neoadjuvant therapy. Bleeding, infectious complications, rectal stenosis, perforations, and death were evaluated.
Results A total of 35 patients were treated using TAMIS without closure of the defect. The average size of the lesions was of 3.68 ± 2.1 cm (95% confidence interval [95%CI]: 0.7 cm to 9 cm), their average distance from the anal margin was of 5.7 ± 1.48 cm, and the average operative time was of 39.2 ± 20.5 minutes, with a minimum postoperative follow-up of 1 year. As for the pathologies, they were: 15 adenomas; 3 carcinoid tumors; and 17 adenocarcinomas. In all cases, the rectal defect was left open.The overall morbidity was of 14.2%. Two patients (grade II in the Clavien-Dindo classification) were readmitted for pain treatment, and three patients (grade III in the Clavien-Dindo classification) were assisted due to postoperative bleeding, one of whom required reoperation.
Conclusion The TAMIS technique without closure of the rectal defect yields good results, and present a high feasibility and low complication rate.
Collapse
Affiliation(s)
- Diego Naiderman
- Coloproctology Sector, Hospital Interzonal General de Agudos “Dr. Oscar E. Alende” (HIGA), Mar del Plata, Buenos Aires, Argentina
- Centro de Estudios Digestivos, Mar del Plata, Buenos Aires, Argentina
- Clínica Pueyrredón, Mar del Plata, Buenos Aires, Argentina
| | - Ana Laura Tufare
- Universidad Nacional de Mar del Plata, Mar del Plata, Buenos Aires, Argentina
| | | | - Fernando Rossi
- Clínica Pueyrredón, Mar del Plata, Buenos Aires, Argentina
| | - Martín Dolan
- Centro de Estudios Digestivos, Mar del Plata, Buenos Aires, Argentina
| | - Diego Martín Cano
- Coloproctology Sector, Hospital Interzonal General de Agudos “Dr. Oscar E. Alende” (HIGA), Mar del Plata, Buenos Aires, Argentina
| | | | | |
Collapse
|
|
7
|
Kim MJ, Lee TG. Transanal minimally invasive surgery using laparoscopic instruments of the rectum: A review. World J Gastrointest Surg 2021; 13:1149-1165. [PMID: 34754384 PMCID: PMC8554714 DOI: 10.4240/wjgs.v13.i10.1149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/18/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
Transanal minimally invasive surgery (TAMIS) was first described in 2010 as an alternative to transanal endoscopic microsurgery (TEM). The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and early-stage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery. TAMIS has a shorter learning curve, reduced device setup time, flexibility in instrument use, and versatility in application than TEM. Also, TAMIS shows similar results in a view of the operation time, conversion rate, reoperation rate, and complication to TEM. For these reasons, TAMIS is an easily accessible, technically feasible, and cost-effective alternative to TEM. Overall, TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons. As TAMIS becomes more broadly utilized such as pelvic abscess drainage, rectal stenosis, and treatment of anastomotic dehiscence, the acquisition of appropriate training must be ensured, and the continued assessment and assurance of outcome must be maintained.
Collapse
Affiliation(s)
- Myung Jo Kim
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Taek-Gu Lee
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| |
Collapse
|
|
8
|
Keller DS, de Lacy FB, Hompes R. Education and Training in Transanal Endoscopic Surgery and Transanal Total Mesorectal Excision. Clin Colon Rectal Surg 2021; 34:163-171. [PMID: 33814998 DOI: 10.1055/s-0040-1718682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There is a paradigm shift in surgical training, and new tool and technology are being used to facilitate mastery of the content and technical skills. The transanal procedures for rectal cancer-transanal endoscopic surgery (TES) and transanal total mesorectal excision (TaTME)-have a distinct learning curve for competence in the procedures, and require special training for familiarity with the "bottom-up" anatomy, procedural risks, and managing complex cases. These procedures have been models for structured education and training, using multimodal tools, to ensure safe implementation of TES and TaTME into clinical practice. The goal of this work was to review the current state of surgical education, the introduction and learning curve of the TES and TaTME procedures, and the established and future models for education of the transanal procedures for rectal cancer.
Collapse
Affiliation(s)
- Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - F Borja de Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Roel Hompes
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherland
| |
Collapse
|
|
9
|
Devane LA, Burke JP, Kelly JJ, Albert MR. Transanal minimally invasive surgery for rectal cancer. Ann Gastroenterol Surg 2021; 5:39-45. [PMID: 33532679 PMCID: PMC7832961 DOI: 10.1002/ags3.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 11/08/2022] Open
Abstract
Due to the increased uptake of rectal cancer screening and the increasing rates of complete clinical response to chemoradiotherapy, more early-stage and down-staged rectal cancers are being treated. This has triggered surgeons to question the necessity for proctectomy and its associated morbidity and consider local excision and organ preservation in selected cases. Transanal minimally invasive surgery (TAMIS) has evolved as an oncologically safe yet cost-effective platform for local excision of rectal tumors using traditional laparoscopic instruments. This review highlights the recent advances and current role of TAMIS in the treatment of rectal cancer.
Collapse
Affiliation(s)
- Liam A. Devane
- Department of Colorectal SurgeryBeaumont HospitalDublinIreland
| | - John P. Burke
- Department of Colorectal SurgeryBeaumont HospitalDublinIreland
| | | | | |
Collapse
|
|
10
|
Hayashi S, Takayama T, Ikarashi M, Hagiwara K, Matsuno Y, Suzuki T. Transanal minimally invasive surgery for rectal neuroendocrine tumors. Surg Endosc 2020; 35:6746-6753. [PMID: 33237462 DOI: 10.1007/s00464-020-08178-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no literature that mainly searched for rectal neuroendocrine tumor (rNET) using transanal minimal invasive surgery (TAMIS). We report our clinical experiences of TAMIS for rectal neuroendocrine tumors to evaluate the feasibility and safety. METHODS Between December 2010 and March 2020, the 25 consecutive patients with rectal neoplasma underwent the TAMIS procedure performed by single laparoscopic surgeon at the two hospitals. Of these, ten patients with rectal neuroendocrine tumors were reviewed retrospectively. The full-thickness excision down to the outer fatty tissues was completed using TAMIS technique. Clinicopathological findings, perioperative and postoperative complications were recorded. RESULTS TAMIS for small rNET was successfully completed in all cases. There were seven cases with a tumor size of less than 10 mm, and three cases with a tumor size between 10 and 15 mm. Six patients underwent the primary tumor excision; the remaining four patients underwent resection for the scar after endoscopic procedure. The median surgical duration was 80.5 (53-124) minutes and the median blood loss was 1 (1-12) ml. All removed tumors in the 6 primary excisions were diagnosed as neuroendocrine tumor G1. The margins of specimens were completely free in all cases. Among the four patients after endoscopic procedure, all had no histological evidence of residual tumor. The median length of hospital stay was 7 days postoperatively. There was no post-operative mortality or severe complication. The median length of observation was 54 months. No recurrence, no local or distant metastasis and no mortality of all patients were observed. CONCLUSIONS TAMIS is safety and feasible procedure for small rNET. Further experience and clinical trials are needed to fully define the advantages, disadvantages, and indications of TAMIS for rNET.
Collapse
Affiliation(s)
- Shigeoki Hayashi
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahito Ikarashi
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ken Hagiwara
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yoritaka Matsuno
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takeki Suzuki
- Department of Surgery, Toride-Kitasouma Medical Association Hospital, 1926 Nonoi, Toride, Ibaraki, 302-0032, Japan
| |
Collapse
|
|
11
|
Abutaka A, Ahmed A, Abunada M, Kurer M. Transanal Minimally Invasive Surgery (TAMIS) in Qatar: initial experience. BMC Surg 2020; 20:138. [PMID: 32560638 PMCID: PMC7304083 DOI: 10.1186/s12893-020-00797-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/12/2020] [Indexed: 01/01/2023] Open
Abstract
Background Transanal Minimally Invasive Surgery (TAMIS) has revolutionized local excision of mid and high rectal lesions; benign or malignant. It is a technique that is developed as a hybrid between Transanal Endoscopic Microsurgery (TEM) and laparoscopic surgery for resection of rectal lesions. Methods We retrospectively reviewed prospectively collected data on patients who underwent TAMIS for benign and early malignant rectal lesions between Jan 2015 and Sept 2019, at Hamad General Hospital, Doha, Qatar. We assessed the following outcomes: feasibility, fragmentation of specimen, operative time, length of stay (LOS) post-operative complications, and margin negativity. Results Seventeen consecutive patients underwent TAMIS for benign and malignant rectal lesions. The average length of stay (LOS) is 1.5 days (1–6 days). Seven patients had different types of benign adenomas, five patients had proven adenocarcinoma, three patients had well-differentiated neuroendocrine tumors, one patient with hyperplastic polyp, and one patient had inflammatory polyp. No fragmentation occurred or detected by histopathologic examination, except in a patient who had inflammatory polyp, where the lesion removed in two fragments. Conclusion TAMIS procedure is feasible and safe even in a relatively low-volume colorectal unit. Using this tool, many patients can avoid unnecessary radical surgery. Therefore, we believe that TAMIS should form part of every specialized colorectal service repertoire. To our knowledge, this is the largest series in the gulf region.
Collapse
Affiliation(s)
- A Abutaka
- Colorectal Surgery Section, Department of Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar
| | - A Ahmed
- Colorectal Surgery Section, Department of Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar
| | - M Abunada
- Colorectal Surgery Section, Department of Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar
| | - M Kurer
- Colorectal Surgery Section, Department of Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar.
| |
Collapse
|
|
12
|
Comparison of Transanal Minimally Invasive Surgery (TAMIS) and Transanal Endoscopic Operations (TEO). Indian J Surg 2019. [DOI: 10.1007/s12262-019-01943-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
|
13
|
Castaño Llano R, Puerta Díaz JD, Palacios Fuenmayor LJ, Uribe Moreno D. Cirugía mínimamente invasiva transanal (TAMIS): técnica y resultados de la experiencia inicial. ACTA ACUST UNITED AC 2019. [DOI: 10.22516/25007440.392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Antecedentes: la cirugía transanal endoscópica es un abordaje mínimamente invasivo recientemente descrito, que provee una exposición superior y permite el acceso a las lesiones del recto en toda su extensión. Además, provee un riesgo menor de compromiso de los márgenes de resección, menores tasas de recurrencia y una menor morbimortalidad en comparación con la escisión transanal convencional o las remociones endoscópicas. Objetivos: se pretende describir la experiencia inicial y los resultados con la cirugía transanal mínimamente invasiva (transanal minimally invasive surgery, TAMIS) en términos de resecciones completas y posibles complicaciones relacionadas con el procedimiento. Materiales y métodos: esta una serie de casos con un seguimiento prospectivo de los pacientes con TAMIS. Se analizaron los resultados de 27 pacientes intervenidos en varios centros de Medellín, Colombia, entre enero de 2012 y diciembre de 2016, realizados con cirugía laparoscópica monopuerto (single-port laparoscopic surgery, SILS) (21 casos) o el GelPOINT® Path (6 casos), junto con el apoyo de la óptica del laparoscopio (16 pacientes) y del endoscopio flexible (11 pacientes). Resultados: se realizaron 27 TAMIS en el mismo número de pacientes, 10 mujeres (37 %) y 17 hombres fueron evaluados. Se realizó un seguimiento a los pacientes durante aproximadamente 12 meses, en promedio 32 meses. La edad promedio fue de 68 años (52-83 años). El tamaño promedio del tumor fue de 5,3 cm (2-9 cm) y la distancia promedio desde el margen anal fue de 7 cm (5-9 cm) Las complicaciones posoperatorias se dieron en 6 casos (22 %) Una perforación rectal se corrigió por vía laparoscópica en el mismo acto quirúrgico y otra por la misma vía transanal. Una estenosis rectal se manejó con dilatación digital, y hubo un caso de sangrado rectal menor, uno de retención urinaria y un paciente presentó un cáncer rectal avanzado a los tres meses de la resección con margen microscópico positivo (4 %). No hubo reingresos. La mortalidad por la intervención fue nula. La patología operatoria reportó la presencia de adenoma de bajo grado en 3 casos (11 %), de alto grado en 11 (41 %), adenocarcinoma in situ en 6 (22 %), tumor neuroendocrino en 5 pacientes (18 %), 1 caso de fibrosis cicatricial (4 %) y 1 de leiomioma (4 %). Limitaciones: los resultados no son extrapolables a la población general debido al poco número de intervenciones y la ejecución limitada a solo dos autores. Conclusiones: en nuestra experiencia inicial, TAMIS es un procedimiento mínimamente invasivo con una baja morbilidad posoperatoria, es curativa para lesiones benignas y para pacientes seleccionados con cáncer temprano.
Collapse
|
|
14
|
Current Trends on the Status of Transanal Endoscopic Microsurgery. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
15
|
Chen N, Peng YF, Yao YF, Gu J. Trans-anal minimally invasive surgery for rectal neoplasia: Experience from single tertiary institution in China. World J Gastrointest Oncol 2018; 10:137-144. [PMID: 29988893 PMCID: PMC6033710 DOI: 10.4251/wjgo.v10.i6.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/26/2018] [Accepted: 05/30/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the feasibility and safety of trans-anal minimally invasive surgery (TAMIS) from single institute in China. METHODS A retrospective review was conducted for patients with rectal neoplasia, who underwent TAMIS using single incision laparoscopic surgery-Port from January 2013 till January 2016 by a group of colorectal surgeons from Gastrointestinal Center Unit III, Peking University Cancer Hospital. Patients' demographic data, surgical related information, post-operational pathology, as well as peri-operative follow-up were all collected. RESULTS Twenty-five patients with rectal neoplasia were identified consequently. Complete full-thickness excision was achieved in all cases without conversion. 22 (88%) cases had rectal malignancies [6 were adenocarcinomas and 16 were neuroendocrine tumors (NET)], while 3 patients had adenomas. Mean surgical duration was 61.3 min, and mean post-operative stay were 2.7 d. Post-operational examination demonstrated 5 cases had positive resection margin: 2 adenocarcinoma cases and 1 NET case with positive lateral margin, and the other 2 NET cases with positive basal margin. The curve of operation time for TAMIS cases suggested a minimum of 10 cases for a laparoscopic surgeon proficient with this technique. CONCLUSION TAMIS was demonstrated to be reproducible and safe, with a relatively short learning process for laparoscopic surgeons in selected cases for rectal neoplasia. Long-term oncological outcome needs to be determined by further investigation.
Collapse
Affiliation(s)
- Nan Chen
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Yi-Fan Peng
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Yun-Feng Yao
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Jin Gu
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| |
Collapse
|
|
16
|
Allaix ME, Arezzo A, Nestorović M, Galosi B, Morino M. Local excision for rectal cancer: a minimally invasive option. MINERVA CHIR 2018; 73:548-557. [PMID: 29658675 DOI: 10.23736/s0026-4733.18.07702-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transanal excision (TAE) with conventional retractors and transanal endoscopic microsurgery (TEM) are two well established minimally invasive surgical options for the treatment of selected rectal cancers. TEM is nowadays considered the standard of care for the transanal excision of rectal tumors, since it is associated with significantly better quality of excision and lower rates of recurrence than TAE. When compared with rectal resection and total mesorectal excision, TEM has lower postoperative morbidity and better functional outcomes, with similar long-term survival rates in selected early rectal cancers. More recently, transanal minimally invasive surgery (TAMIS) has been developed as an alternative to TEM. Possible benefits of TAMIS are under evaluation.
Collapse
Affiliation(s)
- Marco E Allaix
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Bianca Galosi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy -
| |
Collapse
|
|
17
|
Caycedo-Marulanda A, Jiang HY, Kohtakangas EL. Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique. Can J Surg 2017; 60:416-423. [PMID: 29173260 DOI: 10.1503/cjs.002417] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Transanal minimally invasive surgery (TAMIS) has emerged as a relatively new technique in treating early cancer and benign lesion of the rectum. The technique is likely to be widely adopted, surpassing other comparable techniques owing to its simple setup and cost-effectiveness. We assessed the outcomes of TAMIS at our centre. METHODS We retrospectively reviewed prospectively collected data on 50 patients who underwent TAMIS for benign, malignant T1 or T2 cancers that were unfit for radical surgery over a 4-year period. Outcomes, including 30-day complications and recurrence, as well as our ability to implement and integrate this technique at our centre were assessed. RESULTS All 50 TAMIS procedures were successful. The average lesion was 7 cm from the anal verge, the average tumour size was 2.5 cm, the average duration of surgery was 73 minutes, the average length of stay was 1.1 days, and the margin negativity was 84%. Major indications in our series included 25 lesions that were too large for endoscopic resection, 14 early cancers or high-grade dysplasia, 10 margin checks postpolypectomy, 6 cases of recurrent polyposis, and 4 medically unfit patients. There were no deaths. The rate of short-term complications, including rectal bleeding, reoperation and urinary retention, was 16%. The rate of long-term complications, including anal incontinence and stenosis, was 4%. Benign and malignant recurrence rates were 2% and 6%, respectively. Overall long-term requirement for invasive procedures, low anterior resection or abdominoperineal resection, was 12%. CONCLUSION To our knowledge, this is the first Canadian study showing TAMIS to be an efficient and safe procedure for the treatment of well-selected patients with rectal lesions. Outcomes from our centre are comparable with those found in the literature.
Collapse
Affiliation(s)
- Antonio Caycedo-Marulanda
- From the Department of Surgery, Health Sciences North, Sudbury, Ont. (Caycedo-Marulanda, Jiang, Kohtakangas); and the Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, Ont. (Caycedo-Marulanda, Jiang, Kohtakangas)
| | - Henry Y Jiang
- From the Department of Surgery, Health Sciences North, Sudbury, Ont. (Caycedo-Marulanda, Jiang, Kohtakangas); and the Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, Ont. (Caycedo-Marulanda, Jiang, Kohtakangas)
| | - Erica L Kohtakangas
- From the Department of Surgery, Health Sciences North, Sudbury, Ont. (Caycedo-Marulanda, Jiang, Kohtakangas); and the Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, Ont. (Caycedo-Marulanda, Jiang, Kohtakangas)
| |
Collapse
|
|
18
|
Transanal minimally invasive surgery for rectal polyps and selected malignant tumors: caution concerning intermediate-term functional results. Int J Colorectal Dis 2017; 32:1677-1685. [PMID: 28905101 DOI: 10.1007/s00384-017-2893-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Transanal minimally invasive surgery (TAMIS) is gaining worldwide popularity as an alternative for the transanal endoscopic microsurgery (TEMS) method for the local excision of rectal polyps and selected neoplasms. Data on patient reported outcomes regarding short-term follow-up are scarce; data on functional outcomes for long-term follow-up is non-existent. METHODS We used the fecal incontinence severity index (FISI) to prospectively assess the fecal continence on the intermediate-term follow-up after TAMIS. The primary outcome measure is postoperative fecal continence. Secondary outcome measures are as follows: perioperative and intermediate-term morbidity. RESULTS Forty-two patients (m = 21:f = 21), median age 68.5 (range 34-94) years, were included in the analysis. In four patients (9.5%), postoperative complications occurred. The median follow-up was 36 months (range 24-48). Preoperative mean FISI score was 8.3 points. One year after TAMIS, mean FISI score was 5.4 points (p = 0.501). After 3 years of follow-up, mean FISI score was 10.1 points (p = 0.01). Fecal continence improved in 11 patients (26%). Continence decreased in 20 patients (47.6%) (mean FISI score 15.2 points, [range 3-31]). CONCLUSIONS This study found that the incidence of impaired fecal continence after TAMIS is substantial; however, the clinical significance of this deterioration seems minor. The present data is helpful in acquiring informed consent and emphasizes the need of proper patient information. Functional results seem to be comparable to results after TEMS. Furthermore, we confirmed TAMIS is safe and associated with low morbidity.
Collapse
|
|
19
|
deBeche-Adams T, Hassan I, Haggerty S, Stefanidis D. Transanal Minimally Invasive Surgery (TAMIS): a clinical spotlight review. Surg Endosc 2017; 31:3791-3800. [DOI: 10.1007/s00464-017-5636-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/03/2017] [Indexed: 02/07/2023]
|
|
20
|
Glove Port Transanal Excision of Rectal Tumors an Alternative Method for Rectal Tumor Excision: Single Center Experience. Surg Laparosc Endosc Percutan Tech 2017; 27:e53-e56. [PMID: 28614168 DOI: 10.1097/sle.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Transanal minimal invasive surgery has been practiced for several years for excision of rectal tumors however there is no standard consensus about its applications. This minimally invasive approach helps in avoiding major rectal resections and its associated risk of mortality and morbidity.The aim of this study is to describe a single center experience with transanal glove port excision of rectal tumors which are not amenable to colonoscopic excision. MATERIALS AND METHODS Between the years 2011 and 2014, 9 patients underwent glove port excision of rectal tumors located within 15 cm from the anal verge. Glove port was constructed using circular anal dilator, standard surgical glove and a wound protector retractor; regular laparoscopic instruments were used. The median follow-up period was for 18 months (range, 9 to 27 mo) and all patients had flexible sigmoidoscopy for follow-up to look for any recurrence of the tumors. RESULTS All patients underwent transanal excision of rectal tumors successfully using glove port device and laparoscopic instruments. Full thickness excision of the tumor was performed in all patients and there was no significant postoperative morbidity. The final histology of 6 patients was benign and the remaining 3 patients had malignancy reported in the specimen. During the follow-up period between 12 and 18 months 3 patients had a recurrence of the polyp which was removed endoscopically without the need for any further surgical intervention. CONCLUSIONS Glove port excision of rectal tumors is a feasible alternative to conventional surgical treatment for large benign rectal tumors.What does this paper add to the literature?This article demonstrates that performing local excision of rectal tumors can be achieved safely at a lower cost using simple platforms that are constructed locally like the glove ports. It also highlights the benefits of using the available laparoscopic kits to perform the procedure while making use of the previously acquired skills.
Collapse
|
|
21
|
Sotiropoulos GC, Stamopoulos P, Kykalos S, Machairas N. Conventional transanal excision for a very low gastrointestinal stromal tumour. BMJ Case Rep 2017; 2017:bcr-2016-217424. [PMID: 28432162 DOI: 10.1136/bcr-2016-217424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Gastrointestinal stromal tumour (GIST) represents a rare tumour entity, which has been more intensively investigated during the last decade. The rectum as the primary site of GIST is even uncommon. The space constraints in the pelvis renders optimal oncological surgery demanding and proximity of these lesions to the anal sphincter enhances the potential morbidity of any radical surgery. We herein report on a young patient with a >5 cm rectal GIST localised at 1 cm from the anorectal junction.
Collapse
Affiliation(s)
- Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevas Stamopoulos
- Second Department of Propaedeutic Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Kykalos
- Second Department of Propaedeutic Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
|
22
|
Quaresima S, Balla A, Franceschilli L, La Torre M, Iafrate C, Shalaby M, Di Lorenzo N, Sileri P. Transanal Minimally Invasive Surgery for Rectal Lesions. JSLS 2017; 20:JSLS.2016.00032. [PMID: 27547025 PMCID: PMC4978546 DOI: 10.4293/jsls.2016.00032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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.
Collapse
Affiliation(s)
- Silvia Quaresima
- Department of General Surgery; University of Rome "Tor Vergata," Rome, Italy
| | - Andrea Balla
- Department of General Surgery; University of Rome "Tor Vergata," Rome, Italy
| | - Luana Franceschilli
- Department of General Surgery; University of Rome "Tor Vergata," Rome, Italy
| | - Marco La Torre
- Department of General Surgery; University of Rome "Tor Vergata," Rome, Italy
| | - Corrado Iafrate
- Department of General Surgery; University of Rome "Tor Vergata," Rome, Italy
| | - Mostafa Shalaby
- Department of General Surgery; University of Rome "Tor Vergata," Rome, Italy
| | - Nicola Di Lorenzo
- Department of General Surgery; University of Rome "Tor Vergata," Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery; University of Rome "Tor Vergata," Rome, Italy
| |
Collapse
|
|
23
|
Richter-Schrag HJ, Walker C, Thimme R, Fischer A. [Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon]. Chirurg 2017; 87:316-25. [PMID: 26438202 DOI: 10.1007/s00104-015-0091-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The diagnostic validity of a full-thickness resection is higher compared to endoscopic mucosal resection (EMR) or endoscopic mucosal dissection (ESD). Whereas transanal endoscopic microsurgery techniques (TEM, TAMIS) are established therapeutic procedures in the rectum no established and safe minimally invasive or endoscopic procedure exists in the colon. AIM In this study the novel endoscopic full thickness resection device (FTRD, Ovesco, Germany) was investigated concerning success rates with histologically proven full thickness resections, R0 status as well as patient and device safety for the rectum and colon. METHOD In the period from November 2014 to June 2015 full thickness resections in the rectum and colon were performed with the FTRD in 20 patients. Data on technical success, R0 resection rate and histologically confirmed full thickness resections were retrospectively analyzed. RESULTS The following indications were treated in the rectum (n = 11) and colon (n = 9): T1 carcinoma (n = 6) and neuroendocrine tumors (n = 2), untreated and nonlifting adenomas (n = 3) and incomplete resection of adenomas with low and high grade dysplasia (n = 9). The technical success rate was 75 %, 3 technical failures made a conventional polypectomy necessary in 2 patients and in 1 patient an operative resection of the duplicated intestinal wall had to be performed. The median endoscopic follow-up time was 61.5 days (n = 10) and in 7 patients the clip had dislodged at the first follow-up. A thermal perforation in one case of conventional polypectomy gave rise to indications for a partial resection of the colon. In one patient the lesion in the cecum could be reached but not treated for technical reasons. The histological R0 rate was 80 %, whereas the full thickness resection rate was 60 % (85.7 % in the colon and 54.6 % in the rectum). In two patients with carcinoma and incomplete FTRD, surgical treatment was performed. The median size of the resection specimen was 5 cm(2) (range 1.6-12.9 cm(2)). CONCLUSION The results show that FTRD is a safe and effective instrument for use in the lower gastrointestinal tract. Limitations of the FTRD system concerning full thickness resection are scarring, fibrosis and thickness of the intestinal wall, especially in the lower rectum; therefore, it is suggested that a simulation with a tube similar in size to the FTRD should be performed during the screening colonoscopy in order to establish whether an endoscopic resection with FTRD is possible.
Collapse
Affiliation(s)
- H-J Richter-Schrag
- Interdisziplinäre Gastrointestinale Endoskopie, Kliniken für Innere Medizin II, Universitätsklinik Freiburg, Sir Hans A. Krebs Strasse, 79106, Freiburg im Breisgau, Deutschland.
| | - C Walker
- Interdisziplinäre Gastrointestinale Endoskopie, Kliniken für Innere Medizin II, Universitätsklinik Freiburg, Sir Hans A. Krebs Strasse, 79106, Freiburg im Breisgau, Deutschland
| | - R Thimme
- Interdisziplinäre Gastrointestinale Endoskopie, Kliniken für Innere Medizin II, Universitätsklinik Freiburg, Sir Hans A. Krebs Strasse, 79106, Freiburg im Breisgau, Deutschland
| | - A Fischer
- Interdisziplinäre Gastrointestinale Endoskopie, Kliniken für Innere Medizin II, Universitätsklinik Freiburg, Sir Hans A. Krebs Strasse, 79106, Freiburg im Breisgau, Deutschland
| |
Collapse
|
|
24
|
Haugvik SP, Groven S, Bondi J, Vågan T, Brynhildsvoll SO, Olsen OC. A critical appraisal of transanal minimally invasive surgery (TAMIS) in the treatment of rectal adenoma: a 4-year experience with 51 cases. Scand J Gastroenterol 2016; 51:855-9. [PMID: 27000415 DOI: 10.3109/00365521.2016.1157891] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to describe feasibility, postoperative morbidity, and histological outcome of transanal minimally-invasive surgery (TAMIS) in patients with rectal adenoma. MATERIAL AND METHODS All patients who underwent TAMIS at a single institution from December 2011 to December 2015 were retrospectively included in the study. Feasibility was based on tumor size, distance of tumor from the anal verge, operative time, and hospital stay. Thirty-day morbidity was defined by the revised Accordion Classification system. Histological outcome included microscopic resection margin status, specimen fragmentation status, and grading of dysplasia in rectal adenoma. RESULTS A total of 51 patients with rectal adenoma underwent TAMIS. The median tumor diameter was 32 (4-60) mm and the median distance from the anal verge 8 (3-14) cm. Median operative time was 40 (13-116) min and median length of hospital stay was 1 (0-25) days. Overall morbidity was 12% (four grade 1, one grade 2, and one grade 3 complications). 22% had a positive resection margin, whereas 31% had an indefinable resection margin status mostly due to tissue fragmentation. Median follow-up time was 7 (0-40) months. CONCLUSIONS TAMIS is a challenging surgical technique for treatment of rectal adenoma. Our initial experience among 51 patients resulted in a high proportion of positive resection margins and a high fragmentation rate. The role of TAMIS in the treatment of rectal adenoma is to be defined through comparative studies.
Collapse
Affiliation(s)
- Sven-Petter Haugvik
- a Department of Surgery , Drammen Hospital, Vestre Viken Hospital Trust , Drammen , Norway
| | - Sigrid Groven
- a Department of Surgery , Drammen Hospital, Vestre Viken Hospital Trust , Drammen , Norway
| | - Johan Bondi
- a Department of Surgery , Drammen Hospital, Vestre Viken Hospital Trust , Drammen , Norway
| | - Torolf Vågan
- b Department of Pathology , Drammen Hospital, Vestre Viken Hospital Trust , Drammen , Norway
| | - Stig Ove Brynhildsvoll
- b Department of Pathology , Drammen Hospital, Vestre Viken Hospital Trust , Drammen , Norway
| | - Ole Christian Olsen
- a Department of Surgery , Drammen Hospital, Vestre Viken Hospital Trust , Drammen , Norway
| |
Collapse
|
|
25
|
TAMIS for rectal tumors: advancements of a new approach. Updates Surg 2016; 68:93-7. [PMID: 27052544 DOI: 10.1007/s13304-016-0362-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/13/2016] [Indexed: 12/29/2022]
Abstract
TAMIS allows transanal excision of rectal lesions by the means of a single-incision access port and traditional laparoscopic instruments. This technique represents a promising treatment of rectal neoplasms since it guarantees precise dissection and reproducible approaches. From May 2010 to September 2015, we performed excisions of rectal lesions in 55 patients using a SILS port. The pre-operative diagnosis was 26 tumours, 26 low and high grade displasias and 3 other benign neoplasias. 11 patients had a neoadjuvant treatment. Pneumorectum was established at a pressure of 15-20 mmHg CO2 with continuous insufflation, and ordinary laparoscopic instruments were used to perform full thickness resection of rectal neoplasm with a conventional 5-mm 30° laparoscopic camera. The average operative time was 78 min. Postoperative recovery was uneventful in 53 cases: in one case a Hartmann procedure was necessary at two postoperative days due to an intraoperative intraperitoneal perforation; in another case, a diverting colostomy was required at the five postoperative days due to an intraoperative perforation of the vaginal wall. Unclear resection margins were detected in six patients: thereafter five patients underwent radical surgery; the other patient was unfit for radical surgery, but is actually alive and well. Patients were discharged after a median of 3 days. Transanal minimally invasive surgery is an advanced transanal platform that provides a safe and effective method for low rectal tumors. The feasibility of TAMIS also for malignant lesions treated in a neoadjuvant setting could be cautiously evaluated in the future.
Collapse
|
|
26
|
Arezzo A, Cortese G, Arolfo S, Bullano A, Passera R, Galietti E, Morino M. Transanal Endoscopic Operation under spinal anaesthesia. Br J Surg 2016; 103:916-20. [DOI: 10.1002/bjs.10082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 01/23/2023]
Abstract
Abstract
Background
Transanal Endoscopic Operation (TEO®) for rectal benign lesions and early rectal cancer may provide better oncological outcomes than flexible endoscopy. The major advantage of flexible endoscopy is that it does not require general anaesthesia. This prospective observational study assessed the feasibility and safety of TEO® performed under spinal anaesthesia.
Methods
The study population comprised eligible consecutive patients who underwent TEO® under spinal anaesthesia with curative or palliative intent for rectal neoplasms larger than 20 mm in diameter or for recurrent lesions of any size. The primary endpoints were feasibility and safety; secondary endpoints were postoperative pain, as measured on a visual analogue scale, heart rate, systolic and diastolic BP, opioid requested, postoperative nausea or vomiting, and urinary retention.
Results
The study included 50 patients (median age 70 years; 29 men and 21 women). No intraoperative complications occurred. The median duration of operation was 60 (range 20–165) min. No opioids were requested during the perioperative or postoperative period. The median postoperative pain score was 0 at 4, 8, 24 and 48 h after surgery. There were no significant fluctuations in heart rate, systolic and diastolic BP up to 48 h after the procedure (P = 0·379, P = 0·386 and P = 0·617 respectively). Postoperative nausea and vomiting occurred in one patient, and urinary retention in four.
Conclusion
TEO® under spinal anaesthesia was safe and feasible with no conversions to general anaesthesia.
Collapse
Affiliation(s)
- A Arezzo
- General Surgery I, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - G Cortese
- Anaesthesia, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - S Arolfo
- General Surgery I, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - A Bullano
- General Surgery I, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - R Passera
- General Surgery I, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - E Galietti
- Anaesthesia, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - M Morino
- General Surgery I, Department of Surgical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
|
27
|
Allaix ME, Arezzo A, Morino M. Transanal endoscopic microsurgery for rectal cancer: T1 and beyond? An evidence-based review. Surg Endosc 2016; 30:4841-4852. [DOI: 10.1007/s00464-016-4818-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 02/04/2016] [Indexed: 12/17/2022]
|
|
28
|
Keller DS, Tahilramani RN, Flores-Gonzalez JR, Mahmood A, Haas EM. Transanal Minimally Invasive Surgery: Review of Indications and Outcomes from 75 Consecutive Patients. J Am Coll Surg 2016; 222:814-22. [PMID: 27016903 DOI: 10.1016/j.jamcollsurg.2016.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 01/11/2016] [Accepted: 02/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transanal minimally invasive surgery (TAMIS) is an advanced local excision platform that helps overcome technical limitations and morbidity associated with other resection methods. Our goal was to review the indications and outcomes of TAMIS in a large series. STUDY DESIGN A review of a prospective database identified patients who underwent TAMIS from 2010 to 2014. Demographic, perioperative, short-term outcomes, and recurrence data were analyzed. RESULTS There were 75 patients with 76 lesions analyzed. Mean age was 64.0 years (SD 11.6 years) and mean BMI was 27.4 kg/m(2) (SD 4.7 kg/m(2)). Median American Society of Anesthesiologists (ASA) score was 2 (range 1 to 4). There were 59 benign (77.3%) and 17 malignant (22.7%) lesions: 6 pT0, 6 pT1, 4 pT2, and 1 pT3. Median lesion distance from the anal verge was 10 cm (range 6 to 16 cm). Mean operative time was 76.0 minutes (SD 36.1 minutes). Three patients had intraperitoneal entry; all were closed transanally, but 2 had temporary diverting ileostomies fashioned to ensure healing. Median length of stay was 1 day (range 0 to 6). One patient had a fragmented lesion (1.3%). Five patients had positive margins: 2 in palliative pT2 resections, and 3 in pT1, pT2, and gastrointestinal stromal tumor (GIST) patients. They were managed with radical resection (pT1 and pT2 lesions) and surveillance/medical oncology (GIST). Postoperatively, 3 patients had complications (bleeding, rectal stricture, and recto-vaginal fistula), and all were managed nonoperatively. After median follow-up of 39.5 months (range 10.5 to 65.3 months), 1 pT1 patient with negative margins developed a local recurrence and underwent salvage APR. CONCLUSIONS Transanal minimally invasive surgery is a viable option for excision of benign or early stage rectal masses, with mid-term oncologic outcomes comparable to those of radical resection. Further, TAMIS minimizes the morbidity and can allow more patients to benefit from the minimally invasive approach.
Collapse
Affiliation(s)
- Deborah S Keller
- Colorectal Surgical Associates LLP, LTD, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Reena N Tahilramani
- Colorectal Surgical Associates LLP, LTD, Houston, TX; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX
| | | | - Ali Mahmood
- Colorectal Surgical Associates LLP, LTD, Houston, TX; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Eric M Haas
- Colorectal Surgical Associates LLP, LTD, Houston, TX; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TX.
| |
Collapse
|
|
29
|
Keller DS, Haas EM. Transanal Minimally Invasive Surgery: State of the Art. J Gastrointest Surg 2016; 20:463-9. [PMID: 26608195 DOI: 10.1007/s11605-015-3036-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/17/2015] [Indexed: 01/31/2023]
Abstract
The treatment for rectal cancer and benign rectal lesions continues to progress in the arena of minimally invasive surgery. While surgical excision of the primary mass remains essential for eradication of disease, there has been a paradigm shift towards less invasive resection methods. Local excision is increasing in popularity for its low morbidity and excellent functional results in select patients. Transanal minimally invasive surgery (TAMIS) is a new technology developed to elevate the practice of local excision to state-of-the-art resection. The goal of this article is to evaluate the history, short-term outcomes, and evolution of the TAMIS technique for excision of benign and malignant rectal neoplasia.
Collapse
Affiliation(s)
- D S Keller
- Colorectal Surgical Associates, Houston, TX, USA
- Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - E M Haas
- Colorectal Surgical Associates, Houston, TX, USA.
- Division of Minimally Invasive Colorectal Surgery, Department of Surgery, University of Texas Medical School at Houston, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA.
- Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX, USA.
| |
Collapse
|
|
30
|
Akça O, Zargar H, Autorino R, Brandao LF, Gürler AS, Avşar A, Horuz R, Albayrak S. The transrectal single port laparoscopic radical prostatectomy in a cadaver model. Turk J Urol 2015; 41:78-82. [PMID: 26328206 DOI: 10.5152/tud.2015.40336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/03/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. MATERIALS AND METHODS After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT(®)Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT(®)Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. RESULTS Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. CONCLUSION Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.
Collapse
Affiliation(s)
- Oktay Akça
- Department of Urology, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Homayoun Zargar
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Riccardo Autorino
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Luis Felipe Brandao
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Ahmet Selçuk Gürler
- T.C. Ministry of Justice, Turkish Council of Forensic Medicine, İstanbul, Turkey
| | - Abdullah Avşar
- T.C. Ministry of Justice, Turkish Council of Forensic Medicine, İstanbul, Turkey
| | - Rahim Horuz
- Department of Urology, Medipol University Hospital, İstanbul, Turkey
| | - Selami Albayrak
- Department of Urology, Medipol University Hospital, İstanbul, Turkey
| |
Collapse
|
|
31
|
García-Flórez LJ, Otero-Díez JL. Local excision by transanal endoscopic surgery. World J Gastroenterol 2015; 21:9286-9296. [PMID: 26309355 PMCID: PMC4541381 DOI: 10.3748/wjg.v21.i31.9286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/10/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
Transanal endoscopic surgery (TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years, these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or, in some controlled trials, experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology, like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision.
Collapse
|
|
32
|
Molina G, Bordeianou L, Shellito P, Sylla P. Transanal endoscopic resection with peritoneal entry: a word of caution. Surg Endosc 2015; 30:1816-25. [PMID: 26264697 DOI: 10.1007/s00464-015-4452-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/13/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Peritoneal entry during transanal endoscopic microsurgery (TEM) can usually be managed transanally with full-thickness suture closure by experienced operators. The preliminary safety of transanal minimally invasive surgery (TAMIS) has been demonstrated, but the reported experience with upper rectal tumors is limited. The incidence and management of peritoneal entry during transanal endoscopic surgery across various platforms have not been previously evaluated. METHODS Retrospective analysis of a prospectively maintained database of all transanal endoscopic resections performed at a single institution between January 2008 and December 2014 was conducted. Cases with and without peritoneal entry were evaluated with respect to transanal platform used, surgical indication, size, location and distance from the anal verge, and incidence of postoperative complications. RESULTS A total of 78 transanal endoscopic procedures were performed on 76 patients using the rigid transanal endoscopic operation (TEO, 65.4 %), TEM (26.9 %), and TAMIS platform (7.7 %). The most common surgical indication included endoscopically unresectable adenomas (50 %). The average distance of lesions from the anal verge (AV) was 9.6 cm (range 4-20 cm). Peritoneal entry occurred in 22 cases (28.2 %). Platform used (TAMIS vs. rigid, p < 0.05), mean distance from the AV (p < 0.0001), location along the rectum (p = 0.01), and mean specimen size (p = 0.01) were associated with a higher likelihood of peritoneal entry. All rectal defects associated with peritoneal entry were successfully closed transanally except for two (TEM and TEO) cases that required conversion to laparoscopic low anterior resection and laparoscopic Hartmann's, respectively. There were four TAMIS cases that required conversion to TEO platforms. CONCLUSION In this high-risk TEM, TEO, and TAMIS series (one-third of rectal lesions located in the upper rectum), 91 % of all peritoneal entries were managed transanally without increased morbidity. TAMIS for upper rectal lesions was associated with a high risk of complicated peritoneal entry requiring conversion to a rigid platform.
Collapse
Affiliation(s)
- George Molina
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Paul Shellito
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia Sylla
- Department of Surgery, Mount Sinai Hospital, 5 East 98th Street Box 1249, New York, NY, 10029, USA.
| |
Collapse
|
|
33
|
Burke JP, Albert M. Transanal minimally invasive surgery (TAMIS): Pros and cons of this evolving procedure. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2014.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
|
34
|
Chow OS, Smith JJ, Gollub MJ, Garcia-Aguilar J. Transanal surgery for cT1 rectal cancer: Patient selection, technique, and outcomes. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2014.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
|
35
|
Morino M, Risio M, Bach S, Beets-Tan R, Bujko K, Panis Y, Quirke P, Rembacken B, Rullier E, Saito Y, Young-Fadok T, Allaix ME. Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference. Surg Endosc 2015; 29:755-73. [DOI: 10.1007/s00464-015-4067-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/07/2015] [Indexed: 12/13/2022]
|
|
36
|
Araujo SEA, Mendes CRS, Carvalho GL, Lyra M. Surgeons’ perceptions of transanal endoscopic microsurgery using minilaparoscopic instruments in a simulator: the thinner the better. Surg Endosc 2014; 29:2331-8. [DOI: 10.1007/s00464-014-3956-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/25/2014] [Indexed: 01/11/2023]
|
|
37
|
Abstract
BACKGROUND Currently, the preferred method for local excision of rectal polyps is transanal endoscopic microsurgery, avoiding rectal resection. Transanal minimally invasive surgery is a relatively new technique using a disposable port in combination with conventional laparoscopic instruments. This method is less expensive as compared with transanal endoscopic microsurgery, relatively easy to learn, and available. Despite wide adoption of transanal minimally invasive surgery, to date only a few series on the implementation and use of this technique are reported, and detailed information on the effect of transanal minimally invasive surgery on fecal continence is not available. OBJECTIVE The purpose of this work was to prospectively assess the functional outcome after transanal minimally invasive surgery using the Fecal Incontinence Severity Index preoperatively and postoperatively. DESIGN This was a prospective cohort study. SETTINGS The study was conducted at a large teaching hospital. PATIENTS Patients included those who underwent transanal minimally invasive surgery between October 2011 and September 2013. INTERVENTIONS Transanal minimally invasive surgery was studied. MAIN OUTCOME MEASURES We measured postoperative surgical and functional results. RESULTS A total of 37 patients underwent transanal minimally invasive surgery during our study period. Short-term morbidity rate was 14%, and positive resection margins were reported in 6 cases (16%); in 1 of these patients, a local recurrence was observed. Overall, there was a significant decline in preoperative and postoperative Fecal Incontinence Severity Index scores (p = 0.02), indicating an improvement in anorectal function after transanal minimally invasive surgery for patients with impaired preoperative continence. Seventeen patients (49%) had impaired continence before transanal minimally invasive surgery (mean Fecal Incontinence Severity Index score = 21). Continence improved in 15 (88%) of these patients after surgery; no change was observed in 1 patient (6%), and continence further decreased in another. In addition, 18 patients (51%) had normal preoperative continence (Fecal Incontinence Severity Index score = 0), of which 83% had no change in functionality, and continence decreased in 3. LIMITATIONS No quality of life was measured. CONCLUSIONS Short-term functional results of transanal minimally invasive surgery for rectal polyps are excellent and comparable to functional results using the dedicated transanal endoscopic microsurgery equipment. More research on outcome after transanal minimally invasive surgery is needed to assess morbidity rates and oncologic clearance.
Collapse
|
|
38
|
Bordeianou L, Sylla P, Kinnier CV, Rattner D. Perineal sigmoidopexy utilizing transanal endoscopic microsurgery (TEM) to treat full thickness rectal prolapse: a feasibility trial in porcine and human cadaver models. Surg Endosc 2014; 29:686-91. [DOI: 10.1007/s00464-014-3722-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/30/2014] [Indexed: 01/25/2023]
|
|
39
|
Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S. A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 2014; 18:775-88. [PMID: 24848524 DOI: 10.1007/s10151-014-1148-6] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/10/2014] [Indexed: 12/13/2022]
Abstract
Transanal minimally invasive surgery (TAMIS) was introduced as an alternative to transanal endoscopic microsurgery in 2010. Over the past 4 years, considerable international experience has been gained with this approach. Most published reports focus on TAMIS for local excision of rectal neoplasia, but there are other important applications such as transanal mesorectal excision for rectal cancer. This comprehensive review details the progress with TAMIS since its inception. Robotic transanal surgery is a natural evolution of TAMIS still in its early infancy, which is also reviewed. A comprehensive search of PubMed, EMBASE, the Cochrane Library, and Web of Knowledge was performed. Since the inception of TAMIS in 2009, 33 retrospective studies and case reports, and 3 abstracts have been published on TAMIS for local excision of rectal neoplasms, which represents a combined n = 390 TAMIS procedures performed worldwide using eight different types of TAMIS platforms. A total of 152 lesions were excised for benign disease including adenomas and high-grade dysplasias (39 %), 209 for malignancy for carcinomas in situ and adenocarcinomas (53.5 %). Twenty-nine (7.5 %) of TAMIS resections were for other pathology, of which the majority (23/29) were neuroendocrine lesions. The remaining resections were for mucocele, gastrointestinal stromal tumor, melanoma, and fibrosis. Robotic-TAMIS has also been reported, however, data are extremely limited as there are only 7 case reports (combined n = 11) in the published literature. Success with Robotic-TAMIS has been demonstrated with various patient positions and by use of a special glove port. Transanal total mesorectal excision using the TAMIS platform has also been demonstrated is several small series, and the feasibility of performing pure transanal total mesorectal excision has also been reported. Combined, n = 78 cases of transanal total mesorectal excision have been performed using TAMIS. The advantages of TAMIS-assisted transanal total mesorectal excision are discussed.
Collapse
|
|
40
|
Abstract
Transanal minimally invasive surgery (TAMIS) was introduced as an alternative to transanal endoscopic microsurgery in 2010. Over the past 4 years, considerable international experience has been gained with this approach. Most published reports focus on TAMIS for local excision of rectal neoplasia, but there are other important applications such as transanal mesorectal excision for rectal cancer. This comprehensive review details the progress with TAMIS since its inception. Robotic transanal surgery is a natural evolution of TAMIS still in its early infancy, which is also reviewed. A comprehensive search of PubMed, EMBASE, the Cochrane Library, and Web of Knowledge was performed. Since the inception of TAMIS in 2009, 33 retrospective studies and case reports, and 3 abstracts have been published on TAMIS for local excision of rectal neoplasms, which represents a combined n = 390 TAMIS procedures performed worldwide using eight different types of TAMIS platforms. A total of 152 lesions were excised for benign disease including adenomas and high-grade dysplasias (39 %), 209 for malignancy for carcinomas in situ and adenocarcinomas (53.5 %). Twenty-nine (7.5 %) of TAMIS resections were for other pathology, of which the majority (23/29) were neuroendocrine lesions. The remaining resections were for mucocele, gastrointestinal stromal tumor, melanoma, and fibrosis. Robotic-TAMIS has also been reported, however, data are extremely limited as there are only 7 case reports (combined n = 11) in the published literature. Success with Robotic-TAMIS has been demonstrated with various patient positions and by use of a special glove port. Transanal total mesorectal excision using the TAMIS platform has also been demonstrated is several small series, and the feasibility of performing pure transanal total mesorectal excision has also been reported. Combined, n = 78 cases of transanal total mesorectal excision have been performed using TAMIS. The advantages of TAMIS-assisted transanal total mesorectal excision are discussed.
Collapse
|
|
41
|
McLemore EC, Weston LA, Coker AM, Jacobsen GR, Talamini MA, Horgan S, Ramamoorthy SL. Transanal minimally invasive surgery for benign and malignant rectal neoplasia. Am J Surg 2014; 208:372-81. [PMID: 24832238 DOI: 10.1016/j.amjsurg.2014.01.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 12/27/2013] [Accepted: 01/05/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Transanal minimally invasive surgery (TAMIS), an alternative technique to transanal endoscopic microsurgery, was developed in 2009. Herein, we describe our initial experience using TAMIS for benign and malignant rectal neoplasia. METHODS This is an institutional review board approved, retrospective case series report. RESULTS TAMIS was performed in 32 patients for rectal adenoma (13), adenocarcinoma (16), and carcinoid (3). There were 14 women, with mean age 62 ± 15 years and body mass index 28 ± 5 kg/m(2). Lesion size ranged from .5 to 8.5 cm, distance from the dentate line 1 to 11 cm, and circumference of the lesion 10% to 100%. The mean operative time was 123 ± 62 minutes. Mean hospital length of stay was 2.5 ± 2 days. Complications included urinary tract infection (1), Clostridium difficile diarrhea (1), atrial fibrillation (1), rectal stenosis (1), and rectal bleeding (1). CONCLUSION TAMIS using a disposable transanal access platform is a safe and effective method to remove rectal lesions in this case series.
Collapse
Affiliation(s)
| | - Lynn A Weston
- Department of Surgery, Scripps Health Systems, San Diego, CA, USA
| | - Alisa M Coker
- Department of Surgery, University of California, San Diego, CA, USA
| | - Garth R Jacobsen
- Department of Surgery, University of California, San Diego, CA, USA
| | - Mark A Talamini
- Department of Surgery, University of California, San Diego, CA, USA
| | - Santiago Horgan
- Department of Surgery, University of California, San Diego, CA, USA
| | | |
Collapse
|