Techniques in Coloproctology

, Volume 15, Issue 4, pp 461–464 | Cite as

Robotic transanal minimally invasive surgery in a cadaveric model

  • S. B. Atallah
  • M. R. Albert
  • T. H. deBeche-Adams
  • S. W. Larach
Technical Note


The technique of TransAnal Minimally Invasive Surgery (TAMIS) was pioneered in 2009 as a hybrid approach to endoluminal resections of appropriately selected rectal lesions. There are, however, limitations to performing this type of resection. Robotic TAMIS is a novel, experimental technique and in this study was performed in a cadaveric model at a surgical education center. Various tasks were carried out using robotic TAMIS, including full-thickness sharp and cautery excision of rectal wall, as well as intra-luminal suturing of the surgical defect. It was found that for the da Vinci–trained surgeon, these tasks were simple to perform and accomplished with greater precision when compared to standard TAMIS. Our initial results indicate that robotic TAMIS overcomes the limitations of standard TAMIS and that it is a feasible platform for transanal surgery. The cost, however, of performing robotic TAMIS may limit its application to special cases in which standard TAMIS or transanal endoscopic microsurgery resections may prove difficult. Further study is necessary to validate these preliminary findings before robotic TAMIS is performed on live patients.


Robotic surgery Rectal cancer Transanal endoscopic surgery Local excision 


Conflict of interest

Drs. Albert and Larach are consultants for Applied Medical, Inc. Drs. Atallah, Albert, and Larach are consultants for Covidien.


  1. 1.
    Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H (1985) Transanal endoscopic microsurgery. Leber Magen Darm 15:271–279PubMedGoogle Scholar
  2. 2.
    Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205PubMedCrossRefGoogle Scholar
  3. 3.
    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 249:776–782PubMedCrossRefGoogle Scholar
  4. 4.
    Neary P, Makin GB, White TJ et al (2003) Transanal endoscopic microsurgery: a viable operative alternative in selected patients with rectal lesions. Ann Surg Oncol 10:1106–1111PubMedCrossRefGoogle Scholar
  5. 5.
    Moore J, 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 51:1026–1031PubMedCrossRefGoogle Scholar
  6. 6.
    McCloud JM, Waymont N, Pahwa N et al (2006) Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma. Colorectal Dis 8:581–585PubMedCrossRefGoogle Scholar
  7. 7.
    Whitehouse PA, Tilney HS, Armitage JN, Simson JN (2006) Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas. Colorectal Dis 8:795–799PubMedCrossRefGoogle Scholar
  8. 8.
    Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2009) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc (in press)Google Scholar
  9. 9.
    Doornebosch PG, Tollenaar RA, Gosselink MP et al (2007) Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer. Colorectal Dis 9:553–558PubMedCrossRefGoogle Scholar
  10. 10.
    Lin GL, Meng WC, Lau PY, Qiu HZ, Yip AW (2006) Local resection for early rectal tumours: comparative study of transanal endoscopic microsurgery (TEM) versus posterior trans-sphincteric approach (Mason’s operation). Asian J Surg 29:227–232PubMedCrossRefGoogle Scholar
  11. 11.
    Winde G, Nottberg H, Keller R, Schmid KW, Bunte H (1996) Surgical cure for early rectal carcinomas (T1): transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 39:969–976PubMedCrossRefGoogle Scholar
  12. 12.
    Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284PubMedCrossRefGoogle Scholar
  13. 13.
    Papagrigoriadis S (2006) Transanal endoscopic micro-surgery (TEMS) for the management of large or sessile rectal adenomas: a review of the technique and indications. Int Semin Surg Oncol 3:13PubMedCrossRefGoogle Scholar
  14. 14.
    Maslekar S, Pillinger SH, Sharma A, Taylor A, Monson JR (2007) Cost analysis of transanal endoscopic microsurgery for rectal tumours. Colorectal Dis 9:229–234PubMedCrossRefGoogle Scholar
  15. 15.
    Hottenrott C (2011) Robotic versus laparoscopic surgery for rectal cancer and cost-effectiveness analysis. Surg Endosc (in press)Google Scholar
  16. 16.
    Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ (2010) Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis 12:1084–1093PubMedCrossRefGoogle Scholar
  17. 17.
    Heemskerk J, de Hoog DE, van Gemert WG, Baeten CG, Greve JW, Bouvy ND (2007) Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum 50:1825–1830PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • S. B. Atallah
    • 1
  • M. R. Albert
    • 1
  • T. H. deBeche-Adams
    • 1
  • S. W. Larach
    • 1
  1. 1.Center for Colon and Rectal SurgeryFlorida HospitalOrlandoUSA

Personalised recommendations