S. Larach

Transanal minimally invasive surgery for total mesorectal excision (TAMIS–TME): a stepwise description of the surgical technique with video demonstration

Transanal minimally invasive surgery (TAMIS), which can provide high-quality local excision for rectal neoplasia, has emerged as an important alternative to transanal endoscopic microsurgery. The role of TAMIS beyond local excision has also been explored, and it has been shown that this platform can be used for complete rectal resection with total mesorectal excision (TME). The stepwise approach to TAMIS for TME is described and illustrated in video format.

Robotic transanal minimally invasive surgery in a cadaveric model

The technique of TransAnal Minimally Invasive Surgery (TAMIS) was pioneered in 2009 as a hybrid approach to endoluminal resections of appropriately selected rectal lesions. There are, however, limitations to performing this type of resection. Robotic TAMIS is a novel, experimental technique and in this study was performed in a cadaveric model at a surgical education center. Various tasks were carried out using robotic TAMIS, including full-thickness sharp and cautery excision of rectal wall, as well as intra-luminal suturing of the surgical defect. It was found that for the da Vinci–trained surgeon, these tasks were simple to perform and accomplished with greater precision when compared to standard TAMIS. Our initial results indicate that robotic TAMIS overcomes the limitations of standard TAMIS and that it is a feasible platform for transanal surgery. The cost, however, of performing robotic TAMIS may limit its application to special cases in which standard TAMIS or transanal endoscopic microsurgery resections may prove difficult. Further study is necessary to validate these preliminary findings before robotic TAMIS is performed on live patients.

Robotic-assisted transanal surgery for total mesorectal excision (RATS-TME): a description of a novel surgical approach with video demonstration

A new era has emerged in rectal cancer surgery—transanal total mesorectal excision (TME). Various platforms have been used to facilitate this novel approach, including transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery. We have previously reported the use of TAMIS-TME. This is a report of the first human case of robotic-assisted transanal surgery for TME.

Transanal minimally invasive surgery (TAMIS): applications beyond local excision.

Transanal minimally invasive surgery (TAMIS) is a new technique for the local excision of rectal neoplasia. This platform employs ordinary laparoscopic instruments to achieve high-quality local excision. The TAMIS platform, however, is quite versatile. Described here are applications of TAMIS beyond local excision, ranging from repair of a rectourethral fistula to reverse proctectomy.

Excision of a rectal neoplasm using robotic transanal surgery (RTS): a description of the technique

The approach to local excision of benign and early-stage, well-selected neoplasms of the rectum continues to evolve. We demonstrate here that local excision of a rectal neoplasm using the da Vinci Robotic Surgical System can be successfully performed. To our knowledge, this is the first time robotic transanal surgery (RTS) has been used in this manner.

Technique for constructing an incisionless laparoscopic stoma

Minimally invasive surgery continues to evolve, and with the advent of single-port laparoscopic access incisionless stoma, creation is possible. Outlined below is the technical approach to the incisionless stoma. It can be applied to the construction of ileostomies as well as colostomies, end, or loop stomas. Our early experience reveals favorable outcomes. This is perhaps one of the least technically demanding procedures that can be performed through a single incision laparoscopic port.

Robotic transanal total mesorectal excision with intersphincteric dissection for extreme distal rectal cancer: a video demonstration.

Transanal total mesorectal excision is an important new development for curative-intent, radical resection of distal rectal cancer [1]. Using the transanal minimally invasive surgery (TAMIS) approach [2], it is possible to perform this operation robotically [3]. This video illustrates robotic transanal total mesorectal excision for curative-intent resection. The operation was performed on a 66-year-old female (body mass index 31.6 kg/m), who was diagnosed with synchronous invasive moderately differentiated adenocarcinoma at 25 cm from the anal verge and in the far distal rectum— \4 mm from the dentate line. MRI staging revealed no evidence of lymph node metastasis, and the rectal tumor was staged as cT2. After discussion at multi-disciplinary tumor board, the consensus decision was to proceed with radical surgical resection. The rectal dissection, including intersphincteric dissection was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) and a two-team approach—with laparoscopy from above—was used to complete the resection. Operative time was 316 min; estimated blood loss was 75 ml. There were no operative complications. Final pathology revealed a sigmoid pT2 adenocarcinoma measuring 2 9 2.5 cm and an extreme distal rectal pT2 adenocarcinoma measuring 3 9 3 cm. There were 6 out of 33 lymph nodes positive for metastatic disease. The mesorectal envelope was graded as ‘completely intact’ (Quirke 3). All resection margins were negative, and the final distal margin on the fresh specimen measured 4 mm. This video demonstrates the technique used and shows that even for extreme distal rectal cancer, the robotic transanal approach is feasible and that a high-quality resection can be performed allowing for sphincter preservation and R0 resection.

Stereotactic navigation for TAMIS-TME.

Abstract Stereotactic navigation allows for real-time, image-guided surgery, thus providing an augmented working environment for the operator. This technique can be applied to complex minimally invasive surgery for fixed anatomic targets. Transanal minimally invasive surgery represents a new approach to rectal cancer surgery that is technically demanding and introduces the potential for procedure-specific morbidity. Feasibility of stereotactic navigation for TAMIS-TME has been demonstrated, and this could theoretically translate into improved resection quality by improving the surgeon’s spatial awareness. The future of minimally invasive surgery as it relates to augmented reality and image-guided surgery is discussed.

Vaginal Access Minimally Invasive Surgery (VAMIS) A New Approach to Hysterectomy

Vaginal hysterectomy is the original natural orifice operation. Although one of the most common gynecologic operations performed, the surgical approach has not changed significantly during the past century. This article describes a new approach to hysterectomy using vaginal access minimally invasive surgery (VAMIS). VAMIS hysterectomy is successfully performed on a cadaveric model. The step-by-step description of the surgical technique is depicted with video supplement.

The technical approach to laparoscopic colectomy in patients who have undergone prior abdominoplasty

BackgroundFor those patients undergoing laparoscopic colorectal surgery who have had prior abdominoplasty, cosmetic outcome is important and the technical considerations for laparoscopy in post-abdominoplasty patients have not been previously addressed. The aim of the present study was to define the technical approach to the post-abdominoplasty patient undergoing laparoscopic colorectal surgery after abdominoplasty.MethodsUtilizing the technical approach described, eleven patients underwent laparoscopy after prior abdominoplasty over a 7-year period.ResultsThe majority of patients (10/11) felt their laparoscopic colorectal resection had no adverse effect on the aesthetics of their prior abdominoplasty. From a surgeon’s standpoint, the only significant challenge was due to the loss of abdominal wall compliance.ConclusionsThe surgical approach to laparoscopic colectomy in the post-abdominoplasty patient requires careful planning. Cosmetic outcome is a particularly important consideration for this subset of patients, and this should be appreciated by the operating surgeon.