Teresa deBeche-Adams

Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients.

BACKGROUND: Since its inception in 2009, transanal minimally invasive surgery has been used increasingly in the United States and internationally as an alternative to local excision and transanal endoscopic microsurgery for local excision of neoplasms in the distal and mid rectum. Despite its increasing acceptance, the clinical benefits of transanal minimally invasive surgery have not yet been validated. OBJECTIVE: The aim of this study is to assess the adequacy of transanal minimally invasive surgery for the local excision of benign and malignant lesions of the rectum. DESIGN: This is a retrospective analysis of consecutive patients who underwent transanal minimally invasive surgery for local excision of neoplasms at a single institution. SETTINGS: The study was conducted by a single group of colorectal surgeons at a tertiary referral center. PATIENTS: Eligible patients with early-stage rectal cancer and benign neoplasms were offered transanal minimally invasive surgery as a means for local excision. Data from these patients were collected prospectively in a registry. MAIN OUTCOME MEASURES: The primary outcome measures included the feasibility of transanal minimally invasive surgery for local excision, resection quality, and short-term clinical results. RESULTS: Fifty patients underwent transanal minimally invasive surgery between July 2009 and December 2011. Twenty-five benign neoplasms, 23 malignant lesions, and 2 neuroendocrine tumors were excised. All lesions were excised using transanal minimally invasive surgery without conversion to an alternate transanal platform. The average length of stay was 0.6 days (range, 0–6), and 68% of patients were discharged on the day of surgery. The average distance from the anal verge was 8.1 cm (range, 3–14 cm). All lesions were excised completely with only 2 fragmented specimens (4%). All specimens were removed with grossly negative margins, although 3 (6%) were found to have microscopically positive margins on final pathology. There were 2 recurrences (4%) at 6- and 18-month follow-up. Early complications occurred in 3 patients (6%). No long-term complications were observed at a median follow-up of 20 months. LIMITATIONS: The study was limited by its retrospective nature and midterm follow-up. CONCLUSIONS: Transanal minimally invasive surgery is an advanced transanal platform that provides a safe and effective method for resecting benign neoplasms, as well as carefully selected, early-stage malignancies of the mid and distal rectum.

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-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.

Transanal minimally invasive surgery (TAMIS): a technique that can be used for retrograde proctectomy.

Diseases of the Colon & ReCtum Volume 56: 7 (2013) transanal minimally invasive surgery (tamis) has emerged as an advanced transanal platform for local excision of rectal neoplasia. this platform has also been shown to be suitable for applications beyond local excision. this video (see Video, supplemental Digital Content 1, http://links.lww.com/DCR/a111) demonstrates the technique and approach to performing a tamis proctectomy in a retrograde fashion in a patient who has had a previous subtotal colectomy for ulcerative colitis, and who does not wish to proceed with a restorative ileal pouch-anal procedure.

Uptake of Transanal Total Mesorectal Excision in North America: Initial Assessment of a Structured Training Program and the Experience of Delegate Surgeons.

BACKGROUND: Transanal total mesorectal excision is a new approach to curative-intent rectal cancer surgery. Training and surgeon experience with this approach has not been assessed previously in America. OBJECTIVE: The purpose of this study was to characterize a structured training program and to determine the experience of delegate surgeons. DESIGN: Data were assimilated from an anonymous, online survey delivered to attendees on course completion. Data on surgeon performance during hands-on cadaveric dissection were collected prospectively. SETTINGS: This study was conducted at a single tertiary colorectal surgery referral center, and cadaveric hands-on training was conducted at a specialized surgeon education center. MAIN OUTCOME MEASURES: The main outcome measurement was the use of the course and surgeon experience posttraining. RESULTS: During a 12-month period, eight 2-day transanal total mesorectal excision courses were conducted. Eighty-one colorectal surgeons successfully completed the course. During cadaveric dissection, 71% achieved a complete (Quirke 3) specimen; 26% were near complete (Quirke 2), and 3% were incomplete (Quirke 1). A total of 9.1% demonstrated dissection in the incorrect plane, whereas 4.5% created major injury to the rectum or surrounding structures, excluding the prostate. Thirty eight (46.9%) of 81 surgeon delegates responded to an online survey. Of survey respondents, 94.6% believed training should be required before performing transanal total mesorectal excision. Posttraining, 94.3% of surgeon delegates planned to use transanal total mesorectal excision for distal-third rectal cancers, 74.3% for middle-third cancers, and 8.6% for proximal-third cancers. The most significant complication reported was urethral injury; 5 were reported by the subset of survey respondents who had performed this operation postcourse. LIMITATIONS: The study was limited by inherent reporting bias, including observer and recall biases. CONCLUSIONS: Although this structured training program for transanal total mesorectal excision was found to be useful by the majority of respondents, the risk of iatrogenic injury after training remains high, suggesting that this training pedagogy alone is insufficient. See Video Abstract at http://links.lww.com/DCR/A335.

Transanal Minimally Invasive Surgery.

Transanal minimally invasive surgery (TAMIS) was first described in 2010 as a crossover between single-incision laparoscopic surgery and transanal endoscopic microsurgery (TEM) to allow access to the proximal and mid-rectum for resection of benign and early-stage malignant rectal lesions. The TAMIS technique can also be used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery. Proper workup and staging should be done before surgical decision-making. In addition to the TAMIS port, instrumentation and set up include readily available equipment found in most operating suites. TAMIS has proven its usefulness in a wide range of applications outside of local excision, including repair of rectourethral fistula, removal of rectal foreign body, control of rectal hemorrhage, and as an adjunct in total mesorectal excision for rectal cancer. TAMIS is an easily accessible, technically feasible, and cost-effective alternative to TEM.

Transanal minimally invasive surgery for repair of rectourethral fistula.

Diseases of the Colon & ReCtum Volume 57: 7 (2014) transanal minimally invasive surgery (tamis) has emerged as a practical method for performing advanced transanal surgery. most experience using tamis is for local excision of rectal neoplasia and, more recently, transanal total mesorectal excision. however, other applications are feasible. the application of tamis for the repair of a rectourethral fistula (Ruf) is presented. a symptomatic Ruf developed in a 59-year-old man 9 months after completion of cryoablative therapy for prostate cancer. in preparation for tamis repair, he underwent a diversion of the fecal stream with a laparoscopic loop ileostomy. the patient consented to tamis repair of Ruf with institutional approval. this video demonstrates how tamis can be used to repair the fistula (see Video, supplemental Digital Content 1, http://links.lww.com/DCR/a138). the approach involves coring out the fistulous tract, then performing a layered closure with absorbable suture. this fistula was successfully closed, and the loop ileostomy was subsequently reversed 3 months postoperatively. at 23-month follow-up, the patient is doing well without recurrence or difficulty with urination. to our knowledge, this is the first application of tamis for the repair of a Ruf. this approach is an excellent alternative to more invasive procedures to fistula closure, particularly the transabdominal approach. successful closure of Ruf has also been reported with the use of transanal endoscopic microsurgery; however, data are sparse, with only 3 published reports to date. Rectourethral fistula closure remains a difficult problem, and, for fistulas that are radiation induced, closure in this fashion—without interposition of healthy, nonirradiated tissue—is not likely to result in closure. therefore, a tamis layered repair, as demonstrated in this case, is not recommended for radiated Rufs.

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.