gms | German Medical Science

Objectives: The treatment of benign adenomas and rectal cancer is facing a paradigm shift in the last few years, with the impact of new endoscopic and neoadjuvant concepts. The new concept of transanal resection of rectal masses using an adapted single port platform (TAMIS-transanal minimally invasive surgery) was first clinically introduced by our group in 2009. The present study describes the clinical experience of TAMIS for indications for benign and malign disease.

Methods: Surgical resection was indicated for 8 patients with rectal adenomas and 11 patients with diagnosed rectal adenocarcinoma at middle third of the rectum. IRB approval was obtained at the institution for the study, and the patients signed informed consent. Full thickness resection of large adenomas in middle and upper rectum was performed with transanal single port. Total mesorectal resection and rectosigmoidectomy was performed using single port device directly inserted inside the rectum, and dissection was progressed proximally using perirectal dissection. Laparoscopic assistance was used for IMA ligation and left colon mobilization. Specimens were extracted transanally, and stappled or sutured transorificial anastomosis was performed.

Results: All 19 patients were submitted to TAMIS. Operative time was a mean of 48 min for Adenomas and 290 min for rectal resection. One patient was converted to laparoscopic surgery and one to open surgery due to bulky tumors. One patient presented necrosis of the coloanal anastomosis and was reoperated. One patients required readmission for blleding. The postoperative course of the other patients at 30 days was uneventful. Adequate lymphnode count and free margins for benign and malign indications were obtained.

Conclusion: The present study shows that TAMIS can successfully replace many indications of previous TEM for benign disease. The technique can be performed with available technology and reduced learning curve. NOTES access for TME is a promising new therapy besides existing laparoscopic and open surgery to improve patient care.