Surgical Endoscopy

, Volume 33, Issue 2, pp 543–548 | Cite as

Robotic transanal minimally invasive surgery (TAMIS) with the newest robotic surgical platform: a multi-institutional North American experience

  • Shanglei LiuEmail author
  • Toshiaki Suzuki
  • Bryce W. Murray
  • Lisa Parry
  • Craig S. Johnson
  • Santiago Horgan
  • Sonia Ramamoorthy
  • Samuel Eisenstein



Transanal minimally invasive surgery (TAMIS) offers intra-luminal full-thickness excision of rectal neoplasia. Robotic TAMIS (RT) allows for greater versatility in motion while operating in the limited space of the rectum. We present our experience with this technique in practice using the DaVinci Xi™ platform.


This is a multi-institutional retrospective analysis for patient undergoing Robotic TAMIS for resection of rectal lesions at two tertiary referral hospitals in the United States. Morbidity, mortality, anatomic measurement, and final pathology were analyzed.


Thirty-four patients planned for Robotic TAMIS were identified. Average follow-up was 188 days. The average BMI was 29.5 ± 5.9. All patients had an American Society of Anesthesiologist (ASA) Class of 2 or greater and 21 (62%) were ASA 3 or greater. Rectal lesions located from 2 to 15 cm from the dentate line were successfully resected. Lesions up to 4.5 cm in the longest dimension were successfully resected. The average operative time was 100 ± 70 min, which correlated to a robotic console time of 76 ± 67 min. Patients were placed in Lithotomy in 32 (94%) cases and were prone in only 2 (6%) cases. There were no intraoperative complications or conversions to another technique. The only postoperative complication was a medically managed Clostridium difficile infection in 1 patient. Three patients were upstaged to T2 on final pathology and underwent successful formal resections. BMI was a statistically significant predictor of a longer operation.


With increased reach and operative range of motion, Robotic TAMIS is a safe and effective method for excising low-risk rectal neoplasia with a wide range of anatomical measurements. Higher BMI is a significant predictor of a longer and likely more challenging operation.


Robotic surgery TAMIS Anal cancer Rectal cancer Natural oriface surgery 


Author contributions

Study conception and design—SL, TS, BWM, LP, CSJ, SH, SR, SE. Data acquisition and analysis—SL, TS, BWM, LP, CSJ, SH, SR, SE. Drafting or revising the article—SL, TS, BWM, LP, CSJ, SH, SR, SE. Final approval—SL, TS, BWM, LP, CSJ, SH, SR, SE. Agreement to be accountable for work—SL, TS, BWM, LP, CSJ, SH, SR, SE.

Compliance with ethical standards


Drs. Shanglei Liu, Toshiaki Suzuki, Bryce W. Murray, Lisa Parry, Craig S. Johnson, Santiago Horgan, Sonia Ramamoorthy, and Samuel Eisenstein have no conflicts of interest or financial ties to disclose.


  1. 1.
    Buess G, Kipfmuller K, Hack D et al (1988) Technique of transanal endoscopic microsurgery. Surg Endosc 2:71–75CrossRefGoogle Scholar
  2. 2.
    Buess G, Hutterer F, Theiss J et al (1984) A system for a transanal endoscopic rectum operation. Chirurg 55(10):677–680 (in German)Google Scholar
  3. 3.
    Allaix ME, Arezzo A, Caldart M et al (2009) Transanal endoscopic microsurgery for rectal neoplasms: experience of 300 consecutive cases. Dis Colon Rectum 52:1831–1836CrossRefGoogle Scholar
  4. 4.
    Guerrieri M, Baldarelli M, Organetti L et al (2008) Transanal endoscopic microsurgery for the treatment of selected patients with distal rectal cancer: 15 years experience. Surg Endosc 22(9):2030–2035CrossRefGoogle Scholar
  5. 5.
    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(6):553–558CrossRefGoogle Scholar
  6. 6.
    Lin GL, Meng WC, Lau PY et al (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(4):227–232CrossRefGoogle Scholar
  7. 7.
    Winde G, Nottberg H, Keller R et al (1996) Surgical cure for early rectal carcinomas (T1). Transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 39(9):969–976CrossRefGoogle Scholar
  8. 8.
    Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48(2):270–284CrossRefGoogle Scholar
  9. 9.
    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 3:13CrossRefGoogle Scholar
  10. 10.
    Maslekar S, Pillinger SH, Sharma A et al (2007) Cost analysis of transanal endoscopic microsurgery for rectal tumours. Colorectal Dis 9(3):229–234CrossRefGoogle Scholar
  11. 11.
    Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24(9):2200–2205CrossRefGoogle Scholar
  12. 12.
    Lim SB, Seo SI, Lee JL et al (2012) Feasibility of transanal minimally invasive surgery for mid-rectal lesions. Surg Endosc 26(11):3127–3132CrossRefGoogle Scholar
  13. 13.
    Barendse RM, Doornebosch PG, Bemelman WA et al (2012) Transanal employment of single access ports is feasible for rectal surgery. Ann Surg 256(6):1030–1033CrossRefGoogle Scholar
  14. 14.
    Lorenz C, Nimmesgern T, Back M et al (2010) Transanal single port microsurgery (TSPM) as a modified technique of transanal endoscopic microsurgery (TEM). Surg Innov 17(2):160–163CrossRefGoogle Scholar
  15. 15.
    Hideki K, Chiharu I (2012) Mechanical analysis of the formation of forceps and scope for single-port laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 22(4):e168–e175CrossRefGoogle Scholar
  16. 16.
    Hompes R, Rauh SM, Hagen ME et al (2012) Preclinical cadaveric study of transanal endoscopic da Vinci® surgery. Br J Surg 99(8):1144–1148CrossRefGoogle Scholar
  17. 17.
    Atallah SB, Albert MR, deBeche-Adams TH et al (2011) Robotic transanal minimally invasive surgery in a cadaveric model. Tech Coloproctol 15(4):461–464CrossRefGoogle Scholar
  18. 18.
    Bardakcioglu O (2013) Robotic transanal access surgery. Surg Endosc 27(4):1407–1409CrossRefGoogle Scholar
  19. 19.
    Hompes R, Rauh SM, Ris F et al (2014) Robotic transanal minimally invasive surgery for local excision of rectal neoplasms. Br J Surg 101(5):578–581CrossRefGoogle Scholar
  20. 20.
    Atallah S, Quinteros F, Martin-Perez B et al (2014) Robotic transanal surgery for local excision of rectal neoplasms. J Robot Surg 8(2):193–194CrossRefGoogle Scholar
  21. 21.
    Vallribera Valls F, Espín Bassany E, Jiménez-Gómez LM et al (2014) Robotic transanal endoscopic microsurgery in benign rectal tumour. J Robot Surg 8(3):277–280CrossRefGoogle Scholar
  22. 22.
    Ruiz MG, Parra IM, Palazuelos CM et al (2015) Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Dis Colon Rectum 58(1):145–153. CrossRefGoogle Scholar
  23. 23.
    Patel MN, Hemal A (2017) Does advancing technology improve outcomes? Comparison of the da Vinci Standard/S/Si to the Xi robotic platforms during robotic nephroureterectomy. J Endourol 27157(336):end.2017.0477. Google Scholar

Copyright information

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

Authors and Affiliations

  1. 1.University of California San Diego Healthcare SystemsLa JollaUSA
  2. 2.Oklahoma Surgical HospitalTulsaUSA
  3. 3.Center for the Future of SurgeryUniversity of California at San DiegoLa JollaUSA

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