Skip to main content
SpringerLink
Log in

Laparoscopic transanal minimally invasive surgery (L-TAMIS) versus robotic TAMIS (R-TAMIS): short-term outcomes and costs of a comparative study

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Transanal minimally invasive surgery (TAMIS) has gained worldwide popularity as a method for the local excision of rectal neoplasms. However, it is technically demanding due to limited working space. Robotic TAMIS offers potential enhanced dexterity and ability while allowing for a more aggressive resection with a stable platform. The objective of this study was to review a single institution experience between laparoscopic (L-TAMIS) and robotic TAMIS (R-TAMIS) for treatment of rectal neoplasms and determine if there are significant differences on outcomes.

Methods

Forty consecutive patients with rectal neoplasms underwent L-TAMIS or R-TAMIS by two colorectal surgeons from January 2012 to April 2017. We retrospectively reviewed a prospectively maintained database to analyze demographics, peri-operative data, pathology, post-operative complications, and cost.

Results

There were no significant differences between L- and R-TAMIS on patient demographics. R-TAMIS showed a statically significant increase in cost of surgery by $880. Median direct cost of L-TAMIS was $3562 compared to $4440.92 for R-TAMIS (p = 0.04). Wider range of total duration for L-TAMIS is likely due to the variability of body habitus and location of rectal neoplasm, which can significantly limit L-TAMIS compare to R-TAMIS. There was a trend toward decreased blood loss in the R-TAMIS group. Mortality was 0% in both groups.

Conclusions

After reviewing our experience, we conclude there is no significant difference between L- and R-TAMIS other than total direct cost. We confirmed that both L- and R-TAMIS are safe and associated with low morbidity. The limitations of this study include its small sample size. In the future, we hope to show promising data on R-TAMIS with increased sample size and experience, which may allow for transanal resection not previously feasible. Studies with long-term follow-up assessing oncological and functional results will be mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moore JS, Cataldo PA, Osler T, Hyman NH (2008) Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 51:1026–1030 (discussion 1030–1021)

    Article  PubMed  Google Scholar 

  2. Christoforidis D, Cho HM, Dixon MR, Mellgren AF, Madoff RD, Finne CO (2009) Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 249:776–782

    Article  PubMed  Google Scholar 

  3. Clancy C, Burke JP, Albert MR, O’Connell PR, Winter DC (2015) Transanal endoscopic microsurgery versus standard transanal excision for the removal of rectal neoplasms: a systematic review and meta-analysis. Dis Colon Rectum 58:254–261

    Article  PubMed  Google Scholar 

  4. de Graaf EJ, Burger JW, van Ijsseldijk AL, Tetteroo GW, Dawson I, Hop WC (2011) Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis 13:762–767

    Article  PubMed  Google Scholar 

  5. Han Y, He YG, Lin MB, Zhang YJ, Lu Y, Jin X, Li JW (2012) Local resection for rectal tumors: comparative study of transanal endoscopic microsurgery vs. conventional transanal excision—the experience in China. Hepatogastroenterology 59:2490–2493

    PubMed  Google Scholar 

  6. Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S (2014) A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 18:775–788

    Article  CAS  PubMed  Google Scholar 

  7. Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205

    Article  PubMed  Google Scholar 

  8. Atallah SB, Albert MR, deBeche-Adams TH, Larach SW (2011) Robotic Transanal minimally invasive surgery in a cadaveric model. Tech Coloproctol 15:461–464

    Article  CAS  PubMed  Google Scholar 

  9. Hompes R, Rauh SM, Ris F, Tuynman JB, Mortensen NJ (2014) Robotic transanal minimally invasive surgery for local excision of rectal neoplasms. Br J Surg 101:578–581

    Article  CAS  PubMed  Google Scholar 

  10. Erenler I, Aytac E, Bilgin IA, Baca B, Hamzaoglu I, Karahasanoglu T (2017) Robotic transanal minimally invasive surgery (R-TAMIS) with the da Vinci Xi System—a video vignette. Colorectal Dis 19:401

    Article  CAS  PubMed  Google Scholar 

  11. Gomez Ruiz M, Cagigas Fernandez C, Alonso Martin J, Cristobal Poch L, Manuel Palazuelos C, Barredo Canibano FJ, Gomez Fleitas M, Castillo Diego J (2017) Robotic assisted transanal polypectomies: is there any indication? Cir Esp 95:601–609

    Article  PubMed  Google Scholar 

  12. Liu S, Suzuki T, Murray BW, Parry L, Johnson CS, Horgan S, Ramamoorthy S, Eisenstein S (2018) Robotic transanal minimally invasive surgery (TAMIS) with the newest robotic surgical platform: a multi-institutional North American experience. Surg Endosc. https://doi.org/10.1007/s00464-018-6329-3

    Article  PubMed  PubMed Central  Google Scholar 

  13. Warren CD, Hamilton AER, Stevenson ARL (2018) Robotic transanal minimally invasive surgery (TAMIS) for local excision of rectal lesions with the da Vinci Xi (dVXi): technical considerations and video vignette. Tech Coloproctol 22(7):529–533

    Google Scholar 

  14. Lee L, Kelly J, Nassif GJ, Keller D, Debeche-Adams TC, Mancuso PA, Monson JR, Albert MR, Atallah SB (2018) Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Surg Endosc 32:1368–1376

    Article  PubMed  Google Scholar 

  15. Clermonts S, van Loon YT, Wasowicz DK, Langenhoff BS, Zimmerman DDE (2018) Comparative quality of life in patients following transanal minimally invasive surgery and healthy control subjects. J Gastrointest Surg 22(6):1089–1097

    Article  Google Scholar 

  16. Lee L, Burke JP, deBeche-Adams T, Nassif G, Martin-Perez B, Monson JR, Albert MR, Atallah SB (2017) Transanal minimally invasive surgery for local excision of benign and malignant rectal neoplasia: outcomes from 200 consecutive cases with midterm follow up. Ann Surg 267(5):910-916

    Google Scholar 

  17. Garcia-Florez LJ, Otero-Diez JL, Encinas-Muniz AI, Sanchez-Dominguez L (2017) Indications and outcomes from 32 consecutive patients for the treatment of rectal lesions by transanal minimally invasive surgery. Surg Innov 24:336–342

    Article  PubMed  Google Scholar 

  18. Keller DS, Tahilramani RN, Flores-Gonzalez JR, Mahmood A, Haas EM (2016) Transanal minimally invasive surgery: review of indications and outcomes from 75 consecutive patients. J Am Coll Surg 222:814–822

    Article  PubMed  Google Scholar 

  19. Maglio R, Muzi GM, Massimo MM, Masoni L (2015) Transanal minimally invasive surgery (TAMIS): new treatment for early rectal cancer and large rectal polyps-experience of an Italian center. Am Surg 81:273–277

    PubMed  Google Scholar 

  20. Karakayali FY, Tezcaner T, Moray G (2015) Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors. J Minim Access Surg 11:257–262

    Article  PubMed  PubMed Central  Google Scholar 

  21. Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW (2013) Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum 56:301–307

    Article  PubMed  Google Scholar 

  22. Lim SB, Seo SI, Lee JL, Kwak JY, Jang TY, Kim CW, Yoon YS, Yu CS, Kim JC (2012) Feasibility of transanal minimally invasive surgery for mid-rectal lesions. Surg Endosc 26:3127–3132

    Article  PubMed  Google Scholar 

  23. Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680

    CAS  PubMed  Google Scholar 

  24. Lee L, Edwards K, Hunter IA, Hartley JE, Atallah SB, Albert MR, Hill J, Monson JR (2017) Quality of local excision for rectal neoplasms using transanal endoscopic microsurgery versus transanal minimally invasive surgery: a multi-institutional matched analysis. Dis Colon Rectum 60:928–935

    Article  PubMed  Google Scholar 

  25. Porter ME (2010) What is value in health care? N Engl J Med 363:2477–2481

    Article  CAS  PubMed  Google Scholar 

  26. Davis BR, Yoo AC, Moore M, Gunnarsson C (2014) Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes. JSLS 18:211–224

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Dr. Robert Heidel for assistance with statistical analysis.

Author information

Authors and Affiliations

  1. University of Tennessee Medical Center at Knoxville, 1934 Alcoa Highway, Bldg. D, Ste. 370, Knoxville, TN, 37920, USA

    Sung G. Lee, Andrew J. Russ & Mark A. Casillas Jr.

Authors
  1. Sung G. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew J. Russ
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark A. Casillas Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design; Acquisition of data; Analysis and interpretation of data; Drafting of manuscript; Critical revision: SGL, AJR, MAC.

Corresponding author

Correspondence to Mark A. Casillas Jr..

Ethics declarations

Disclosures

Drs. Sung Lee, Andrew Russ, and Mark Casillas, Jr. have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material Video 1 (M4V 58076 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S.G., Russ, A.J. & Casillas, M.A. Laparoscopic transanal minimally invasive surgery (L-TAMIS) versus robotic TAMIS (R-TAMIS): short-term outcomes and costs of a comparative study. Surg Endosc 33, 1981–1987 (2019). https://doi.org/10.1007/s00464-018-6502-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6502-8

Keywords

Search

Navigation