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Transanal Minimally Invasive Surgery for Rectal Cancer


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
  • Laparoscopic

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  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. 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.

    CrossRef  Google Scholar 

  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.

    CAS  PubMed  CrossRef  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

  6. Parks AG. A technique for the removal of large villous tumours in the rectum. Proc R Soc Med. 1970;63(Suppl):89–91.

    PubMed Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  CrossRef  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

  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.

    PubMed  CrossRef  Google Scholar 

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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.

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