Surgical Endoscopy

, Volume 33, Issue 6, pp 1981–1987 | Cite as

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

  • Sung G. Lee
  • Andrew J. Russ
  • Mark A. CasillasJr.Email author
2018 SAGES Oral



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.


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.


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.


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.


Transanal minimally invasive surgery (TAMIS) Robotic TAMIS 



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

Author contributions

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

Compliance with ethical standards


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

Supplementary material

Supplementary material Video 1 (M4V 58076 KB)


  1. 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)CrossRefPubMedGoogle Scholar
  2. 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 249:776–782CrossRefPubMedGoogle Scholar
  3. 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 58:254–261CrossRefPubMedGoogle Scholar
  4. 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 13:762–767CrossRefPubMedGoogle Scholar
  5. 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 59:2490–2493PubMedGoogle Scholar
  6. 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 18:775–788CrossRefPubMedGoogle Scholar
  7. 7.
    Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205CrossRefPubMedGoogle Scholar
  8. 8.
    Atallah SB, Albert MR, deBeche-Adams TH, Larach SW (2011) Robotic Transanal minimally invasive surgery in a cadaveric model. Tech Coloproctol 15:461–464CrossRefPubMedGoogle Scholar
  9. 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 101:578–581CrossRefPubMedGoogle Scholar
  10. 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 19:401CrossRefPubMedGoogle Scholar
  11. 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 95:601–609CrossRefPubMedGoogle Scholar
  12. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 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):529–533Google Scholar
  14. 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 32:1368–1376CrossRefPubMedGoogle Scholar
  15. 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):1089–1097CrossRefGoogle Scholar
  16. 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):910-916Google Scholar
  17. 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 24:336–342CrossRefPubMedGoogle Scholar
  18. 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 222:814–822CrossRefPubMedGoogle Scholar
  19. 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 81:273–277PubMedGoogle Scholar
  20. 20.
    Karakayali FY, Tezcaner T, Moray G (2015) Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors. J Minim Access Surg 11:257–262CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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 56:301–307CrossRefPubMedGoogle Scholar
  22. 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 26:3127–3132CrossRefPubMedGoogle Scholar
  23. 23.
    Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680PubMedGoogle Scholar
  24. 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 60:928–935CrossRefPubMedGoogle Scholar
  25. 25.
    Porter ME (2010) What is value in health care? N Engl J Med 363:2477–2481CrossRefPubMedGoogle Scholar
  26. 26.
    Davis BR, Yoo AC, Moore M, Gunnarsson C (2014) Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes. JSLS 18:211–224CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sung G. Lee
    • 1
  • Andrew J. Russ
    • 1
  • Mark A. CasillasJr.
    • 1
    Email author
  1. 1.University of Tennessee Medical Center at KnoxvilleKnoxvilleUSA

Personalised recommendations