Abstract
Disposable single-port surgery devices have been used for transanal minimally invasive surgery (TAMIS). Their advantage, compared to transanal endoscopic microsurgery, is that they do not require special equipment or training. The aim of this study was to assess our initial experience using the single-site laparoscopic (SSL™) access system (Ethicon Endo-Surgery, Cincinnati, OH, USA) for TAMIS. Five patients eligible for local excision of rectal tumors, four males and one female, mean age 58 years (range 50–78), underwent surgery using the SSL™ device. The average distance from anal verge was 4 cm (range 1–6). Four patients had an initial diagnosis of adenoma, and one had a previous endoscopic excision of a T1 adenocarcinoma with positive margins. In one patient, due to the lack of exposure, the procedure was converted to a low anterior resection. In the remaining four patients, average setup time was 7 minutes (range 4–15) and average operative time was 52 minutes (range 38–72). All resection margins were tumor free. There were no postoperative complications. Two of the presumed adenomas were intramucosal adenocarcinomas, while one patient had a T2 tumor and underwent radical surgery. Although at the present time the appropriate use of local excision is still under debate, TAMIS is a technique with great potential. Because of its simplicity and similarity with conventional laparoscopic surgery, it can be learned easily by surgeons not trained in transanal endoscopic microsurgery.
References
Bach SP, Hill J, Monson JR et al (2009) A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290
Inoue Y, Kusunoki M (2010) Resection of rectal cancer: a historical review. Surg Today 40:501–506
Ramirez JM, Aguilella V, Gracia JA et al (2009) Local full-thickness excision as first line treatment for sessile rectal adenomas:long-term results. Ann Surg 249:225–228
Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205
Zacharakis E, Freilich S, Rekhraj S et al (2007) Transanal endoscopic microsurgery for rectal tumors: the St.Mary’s experience. Am J Surg 194:694–698
Nash GM, Weiser MR, Guillem JG et al (2009) Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum 52:577–582
Rocha JJ, Féres O (2008) Transanal endoscopic operation: a new proposal. Acta Cir Bras 23:93–104
Palma P, Horisberger K, Joos A, Rothenhoefer S, Willeke F, Post S (2009) Local excision of early rectal cancer: is transanal endoscopic microsurgery an alternative to radical surgery? Rev Esp Enferm Dig 101:172–178
Kim E, Hwang JM, Garcia-Aguilar J (2008) Local excision for rectal carcinoma. Clin Colorect Cancer 7:376–385
Whitehouse PA, Armitage JN, Tilney HS, Simson JNL (2008) Transanal endoscopic microsurgery: local recurrence rate following resection of rectal cancer. Colorect Dis 10:187–193
Barendse RM, Verlaan T, Bemelman WA et al (2012) Transanal single port surgery: selecting a suitable access port in a porcine model. Surg Innov 19:323–326
Wolthuis AM, Cini C, Penninckx F, D’Hoore A (2011) Transanal single port access to facilitate distal rectal mobilization in laparoscopic rectal sleeve resection with hand-sewn coloanal anastomosis. Tech Coloproctol 16:161–165
Tsai BM, Finne CO, Nordenstam JF, Christoforidis D, Madoff RD, Mellgren A (2010) Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendations. Dis Colon Rectum 53:16–23
Seman M, Bretagnol F, Guedj N, Maggiori L, Ferron M, Panis Y (2010) Transanal endoscopic microsurgery (TEM) for rectal tumor: the first French single-center experience. Gastroenterologie Clinique et Biologique. Elsevier Masson SAS 34:488–493
Melis M, Gruel R, Darwin P, Drachenberg C, Shibata D (2009) Full thickness transanal re-excision following endoscopic removal of malignant rectal polyps. Int J Colorect Dis 22:531–536
Park C, Lee W, Han S, Yun S, Chun H-K (2007) Transanal local excision for preoperative concurrent chemoradiation therapy for distal rectal cancer in selected patients. Surg Today 37:1068–1072
Habr-Gama A, Perez RO, São Julião GP, Proscurshim I, Nahas SC, Gama-Rodrigues J (2010) Factors affecting management decisions in rectal cancer in clinical practice: results from a national survey. Tech Coloproctol 5:45–51
Atallah S, Albert M, Debeche-Adams T, Nassif G, Polavarapu H, Larach S (2013) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol. doi:10.1007/s10151-012-0971-x
Atallah S, Albert M, DeBeche-Adams T, Larach S (2013) Transanal minimally invasive surgery (TAMIS): applications beyond local excision. Tech Coloproctol 17:239–243
Casadesus D (2009) Surgical resection of rectal adenoma: a rapid review. World J Gastroenterol 15:3851–3854
Barendse RM, Doornebosch PG, Bemelman WA, Fockens P, Dekker E, De Graaf EJ (2012) Transanal employment of single access ports is feasible for rectal surgery. Ann Surg 256:1030–1033
Perez RO, Habr-Gama A, Proscurshim I et al (2007) Local excision for ypT2 rectal cancer—much ado about something. J Gastrointest Surg 11:1431–1440
Callender GG, Das P, Rodriguez-Bigas MA et al (2010) Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3 rectal cancer. Ann Surg Oncol 17:441–447
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Sevá-Pereira, G., Trombeta, V.L. & Capochim Romagnolo, L.G. Transanal minimally invasive surgery (TAMIS) using a new disposable device: our initial experience. Tech Coloproctol 18, 393–397 (2014). https://doi.org/10.1007/s10151-013-1036-5
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DOI: https://doi.org/10.1007/s10151-013-1036-5