eTAMIS: endoscopic visualization for transanal minimally invasive surgery
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Transanal endoscopic microsurgical (TEM) resection is associated with improved outcomes compared to transanal excision of rectal lesions. However, TEM equipment requires additional operative setup time, and tumor location dictates patient positioning. In 2010, Drs. Attallah, Albert, and Larach developed an alternative technique, transanal minimally invasive surgery (TAMIS). Herein, we describe our novel experience using endoscopic visualization to perform TAMIS (eTAMIS) to remove a large rectal polyp.
This is a technical note describing a new surgical technique, eTAMIS. The technique is performed with the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA) and a standard single-channel endoscope for visualization. Patient demographics, operative data, and pathologic data were recorded.
eTAMIS was initially performed in a 50-year-old woman with an endoscopically defiant rectal mass discovered on routine screening colonoscopy. The lesion was a tubulovillous adenoma, 10 cm from the anal verge, anterior, and occupied 15–20 % of the circumference. The rectal mass was removed by eTAMIS. The operative time was 101 minutes, and the patient was discharged within 24 h without event. Final pathology revealed a focus of well-differentiated rectal adenocarcinoma with focal invasion into the muscularis mucosa (Haggit level 0, pTis) arising in the head of a pedunculated tubulovillous adenoma. At 1-year follow-up endoscopy, the patient had no evidence of recurrent mass or polyp.
This is the first technical report describing endoscopic visualization for TAMIS. Endoscopic visualization facilitates intraluminal articulation and lens cleaning while minimizing extraluminal instrument collisions. eTAMIS is a practical and logical evolution of the visual approach to natural orifice transluminal endoscopic surgery and laparoendoscopic surgery.
KeywordsEndoscope Rectal mass TAMIS Transanal minimally invasive surgery
We acknowledge Drs. Antonio Lacy and Patricia Sylla for their innovation and surgical leadership in the revolution of transanal endoluminal proctectomy and total mesorectal excision for rectal cancer. We also acknowledge Drs. Attallah, Albert, and Larach for their innovation and development of the TAMIS technique. Last, we acknowledge Dr. Sonia Ramammoorthy for her support and encouragement in developing an innovative transanal endoscopic surgical practice at the University of California, San Diego. Educational grants from Ethicon Endosurgery and Olympus provided additional funding to support research, education, and training conducted at the UC San Diego Center for the Future of Surgery.
Dr. McLemore is a consultant and an instructor for industry sponsored educational events for Applied Medical and Ethicon Endosurgery Dr. Jacobsen is a consultant and an instructor for industry sponsored educational events for Ethicon Endosurgery Dr. Talamini, MD serves on the advisory board and is a consultant for Olympus. He is also a consultant and an instructor for industry sponsored educational events for Ethicon Endosurgery. Dr. Horgan serves on the advisory board and is a consultant for Olympus. He is also a consultant and an instructor for industry sponsored educational events for Ethicon Endosurgery. Dr. Coker has no conflicts of interest or financial ties to disclose.
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