A Diverse Range of Applications of Transanal Minimally Invasive Surgery

Jung Myun Kwak, MD, PhD, Jin Kim, MD, PhD, Seon Hahn Kim, MD, PhD, Sung Ock Suh, MD, PhD. Korea University College of Medicine.

INTRODUCTION: Transanal minimally invasive surgery (TAMIS) has been used increasingly for local excision of neoplasm in the rectum, but can be useful for other various clinical or pathological situations. The aim of this study was to assess the wide range of clinical applications of TAMIS.

METHODS: From September 2010 to September 2013, 15 consecutive patients who underwent TAMIS were identified and analyzed. After a single-incision laparoscopic surgery port was introduced into the anal canal, pneumorectum was established with laparoscopic equipment, followed by transanal procedure with conventional laparoscopic instruments. Indications, surgical results, and perioperative outcomes were determined retrospectively.

RESULTS: Of 15 patients, benign and malignant lesions of the rectum were resected in 12 patients; 5 had neuroendocrine tumors, 2 had tubular adenomas with high-grade dysplasia, 2 had tubular adenoma with low-grade dysplasia, 1 had hyperplastic polyp, 1 had adenocarcinoma, and 1 had multiple polypoid masses which were proven to actinomycosis. In 2 patients who developed anastomotic fistula after low anterior resection for rectal cancer, fistulous openings were closed by primary sutures. In patient who had self-expandable metal stent for the obstructive upper rectal cancer, distal part of the stent was removed for the safe rectal transection. The median distance from the anal verge was 8 (range 4-19) cm. The median operative time was 70 (range 30-255) minutes and the median postoperative hospital stay was 3 (range 1-9) days. There was no conversion to laparoscopic resection, but peritoneal perforation occurred in 1 patient. No postoperative complications were detected except postoperative fever in 2 patients.

CONCLUSIONS: TAMIS is safe and feasible for local excision of various pathologies in the rectum, avoiding radical resection. Other clinical or pathological findings including anastomotic fistula or foreign body in the rectum can be managed by TAMIS.