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Transanal Minimally Invasive Surgery for Rectal Cancer

Abstract

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.

Keywords

  • Rectal cancer
  • Minimally invasive
  • TAMIS
  • Laparoscopic

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Correspondence to Avo Artinyan M.D., M.S. .

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

Key Operative Steps

Key Operative Steps

  1. 1.

    Dilate the anal sphincter with 2–3 fingers.

  2. 2.

    Insert the transanal access channel/port into the anal canal.

  3. 3.

    Insert a sponge/gauze into the proximal rectum.

  4. 4.

    Mark 1-cm margin with hook cautery.

  5. 5.

    Make a full-thickness incision into the perirectal tissue at the distal margin.

  6. 6.

    Dissect the perirectal tissue with blunt and sharp maneuvers.

  7. 7.

    Divide the rectal wall with cautery or ultrasonic shears.

  8. 8.

    Complete dissection circumferentially until resection is complete.

  9. 9.

    Secure the specimen to maintain orientation for pathologic examination.

  10. 10.

    Repair the defect with a single layer of full-thickness multifilament suture(s). May close defect with a single running suture or 2–3 serial running sutures. LapraTys (Ethicon) may be used to secure sutures to obviate knot-tying.

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Artinyan, A. (2015). Transanal Minimally Invasive Surgery for Rectal Cancer. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_27

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_27

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