Transanal Minimally Invasive Surgery for Rectal Cancer

  • Avo ArtinyanEmail author


The indications and utilization of local excision for rectal cancer have been steadily increasing over the past three decades. The introduction of transanal endoscopic microsurgery (TEM) facilitated the local excision of more proximal lesions in the mid and upper rectum. Transanal minimally invasive surgery (TAMIS) is a more recent modification of TEM, wherein disposable transanal ports and single-incision devices are used to gain access to the rectal lumen. Although the fundamental principles of TAMIS are similar to those of TEM, TAMIS is a unique procedure that requires a different skill set. The following chapter highlights the indications, anatomic considerations, technical aspects, and outcomes of this novel procedure.


Rectal cancer Minimally invasive TAMIS Laparoscopic 

Supplementary material

Video 27.1

In this video, the surgeon demonstrates his approach to transanal minimally invasive surgery (TAMIS). (WMV 71,852 kb)


  1. 1.
    Lisfranc J. Memoire sur l’excision de la partie inferieure du rectum devenue carcinomateuse. Mem Ac R Chir. 1833;3:291–302.Google Scholar
  2. 2.
    Miles W. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet. 1908;2:1812–3.CrossRefGoogle Scholar
  3. 3.
    Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69(10):613–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Tilney HS, Heriot AG, Purkayastha S, Antoniou A, Aylin P, Darzi AW, et al. A national perspective on the decline of abdominoperineal resection for rectal cancer. Ann Surg. 2008;247(1):77–84. doi: 10.1097/SLA.0b013e31816076c3.PubMedCrossRefGoogle Scholar
  5. 5.
    Habr-Gama A, Sabbaga J, Gama-Rodrigues J, Sao Juliao GP, Proscurshim I, Bailao Aguilar P, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum. 2013;56(10):1109–17. doi: 10.1097/DCR.0b013e3182a25c4e.PubMedCrossRefGoogle Scholar
  6. 6.
    Parks AG. A technique for the removal of large villous tumours in the rectum. Proc R Soc Med. 1970;63(Suppl):89–91.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H. [A system for a transanal endoscopic rectum operation] Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. Chirurg. 1984;55(10):677–80.PubMedGoogle Scholar
  8. 8.
    Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc. 2010;24(9):2200–5. doi: 10.1007/s00464-010-0927-z.PubMedCrossRefGoogle Scholar
  9. 9.
    Garcia-Aguilar J, Shi Q, Thomas Jr CR, Chan E, Cataldo P, Marcet J, et al. A phase II trial of neoadjuvant chemoradiation and local excision for T2N0 rectal cancer: preliminary results of the ACOSOG Z6041 trial. Ann Surg Oncol. 2012;19(2):384–91. doi: 10.1245/s10434-011-1933-7.PubMedCrossRefGoogle Scholar
  10. 10.
    Benson 3rd AB, Bekaii-Saab T, Chan E, Chen YJ, Choti MA, Cooper HS, et al. Rectal cancer. J Natl Compr Canc Netw. 2012;10(12):1528–64.PubMedGoogle Scholar
  11. 11.
    Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2013;56(5):535–50. doi: 10.1097/DCR.0b013e31828cb66c.PubMedCrossRefGoogle Scholar
  12. 12.
    Salinas HM, Dursun A, Klos CL, Shellito P, Sylla P, Berger D, et al. Determining the need for radical surgery in patients with T1 rectal cancer. Arch Surg. 2011;146(5):540–3. doi: 10.1001/archsurg.2011.76.PubMedCrossRefGoogle Scholar
  13. 13.
    Najarian MM, Belzer GE, Cogbill TH, Mathiason MA. Determination of the peritoneal reflection using intraoperative proctoscopy. Dis Colon Rectum. 2004;47(12):2080–5. doi: 10.1007/s10350-004-0740-7.PubMedCrossRefGoogle Scholar
  14. 14.
    Hussein Q, Artinyan A. Pushing the limits of local excision for rectal cancer: transanal minimally invasive surgery for an upper rectal/rectosigmoid lesion. Ann Surg Oncol. 2014. doi: 10.1245/s10434-013-3457-9.PubMedGoogle Scholar
  15. 15.
    Kumar AS, Coralic J, Kelleher DC, Sidani S, Kolli K, Smith LE. Complications of transanal endoscopic microsurgery are rare and minor: a single institution’s analysis and comparison to existing data. Dis Colon Rectum. 2013;56(3):295–300. doi: 10.1097/DCR.0b013e31827163f7.PubMedCrossRefGoogle Scholar
  16. 16.
    Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW. 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. 2013;56(3):301–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Schafer H, Baldus SE, Holscher AH. Giant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM). Int J Colorectal Dis. 2006;21(6):533–7. doi: 10.1007/s00384-005-0025-1.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Surgical Oncology, Department of SurgeryBaylor College of MedicineHoustonUSA

Personalised recommendations