Transanal Minimally Invasive Surgery (TAMIS)

Abstract

Full-thickness transanal excision is an acceptable alternative to proctectomy for small, benign masses or early-stage cancers in the rectum. Surgical approaches include a traditional, open transanal excision, transanal endoscopic surgery (TEM), or transanal minimally invasive surgery (TAMIS). TAMIS is the most recently developed method and utilizes either a single-incision laparoscopic surgery (SILS) port or a GelPOINT path transanal access platform to insufflate the rectum and excise the lesion using laparoscopic instruments. Advantages of both TEM and TAMIS over the traditional approach include better visualization and overall precision, especially for more proximal lesions. Advantages of TAMIS over TEM include disposable equipment, use of widely available laparoscopic instruments, shorter learning curve, and overall lower cost. Due to the relatively recent advent of this technique, there are not yet long-term outcome data for comparison. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.