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Transanal Access Platform Options and Instrument Innovations

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Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME)

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Abstract

In the last decade, transanal minimally invasive surgery (TAMIS) has generated interest and attracted research directed at the development of novel platforms for transanal access. This approach is used to treat benign and malignant diseases of the rectum, but it can also be adopted to solve special problems including those related to anastomotic complications, fistulae, and stenosis. However, one of the most significant applications of TAMIS is transanal total mesorectal excision (taTME).

There are three main groups of transanal platforms, based on their characteristics, which are nowadays available on the market: flexible, rigid, and semirigid. The transanal instruments can be conventional instruments for abdominal laparoscopy or dedicated instruments for transanal use. In this chapter, a description of the different transanal platforms and instruments is discussed, with special emphasis on instrument innovation for TAMIS and its subsequent application to taTME.

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Editor’s Comment

While transanal access platforms are most often divided by whether or not they are rigid or flexible, this is really an oversimplified division, and it does not highlight the most important difference between the TEM and TAMIS techniques. It is important to realize that TEM and TAMIS are techniques associated with platforms – not platforms alone. Perhaps one of the most important differences in technique is that with TEM, the shaft of the access channel is meant to be navigated to a localized target. In contrast, with TAMIS, the access channel remains seated above the anorectal ring, while the TAMIS instrumentation alone is delivered to the target of interest. TAMIS’ short access channel and free moving camera have made this design quite suitable for working in multiple sectors at various distances from the anal verge without having to reposition the platform, as is the case for most rigid platforms, which require constant readjustment of the Martin Arm. This is one key reason why the TAMIS technique and platform are so commonly used for taTME as opposed to others. Notwithstanding, surgeon preference and resource availability govern which approach is selected for this operation.

Authors’ Disclosures

The author keeps the patent license for the D-Port platform and monocurved instruments manufactured by Karl Storz Endoskope, Tuttlingen, Germany.

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Authors and Affiliations

  1. Saint-Pierre University Hospital, European School of Laparoscopic Surgery, Department of Gastrointestinal Surgery, Brussels, Belgium

    Giovanni Dapri

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  1. Giovanni Dapri
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Correspondence to Giovanni Dapri .

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Editors and Affiliations

  1. AdventHealth Orlando, Oviedo Medical Center, and University of Central Florida College of Medicine, Orlando, FL, USA

    Sam Atallah

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Dapri, G. (2019). Transanal Access Platform Options and Instrument Innovations. In: Atallah, S. (eds) Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME). Springer, Cham. https://doi.org/10.1007/978-3-030-11572-2_23

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  • DOI: https://doi.org/10.1007/978-3-030-11572-2_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-11571-5

  • Online ISBN: 978-3-030-11572-2

  • eBook Packages: MedicineMedicine (R0)

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