Francesco Stipa, MD, PhD, FACS, Emanuele Soricelli, MD, Pietro Delle Site, MD, Ettore Santini, MD. Department of Surgery, Colorectal Surgical Unit. San Giovanni Addolorata Hospital – Rome.
Purpose: Since its introduction in the early 1980s, Transanal Endoscopic Microsurgery (TEM) has become a safe surgical option for large polyps and low risk rectal cancers . Recently single-incision multiport devices have been employed in a wide spectrum of abdominal procedures. In 2010 an innovative technique combining single-port access with the principles of transanal excision, named Transanal Minimally Invasive Surgery (TAMIS), was reported to be a safe and feasible alternative to TEM.
Methods: The video shows the resection of a 3 cm early rectal cancer in a 68 y.o. women with TAMIS approach, using a multichannel port (GelPOINT® Path Transanal Access Platform). As the distal margin of the lesion was very close to the anal verge (< 2 cm), it was dissected transanally with a Park’s retractor before introducing the GelPOINT® device. A full-thickness resection of the lesion was performed with a harmonic scalpel. The side ends of the rectal defect have been repaired with two running absorbable sutures, while the remaining middle portion has been sutured transanally after GelPOINT® removal. Operative time was 60 minutes. No intra- and post-operative complications have been reported. Pathological examination showed a pT1 R0 low well differentiated adenocarcinoma without linfovascular infiltration.