Transanal Minimally Invasive Surgery (TAMIS): An Early Experience

Mark A Casillas, Jr., MD, MS

University of Tennessee Graduate School of Medicine, Department of Surgery

BACKGROUND:
Transanal endoscopic microsurgical (TEM) resection is associated with improved outcomes compared to transanal excision of rectal lesions. However, TEM equipment requires additional startup cost. Transanal minimally invasive surgery (TAMIS) was first reported in 2010. The purpose of this study was to review our initial experience with TAMIS.

METHODS:
Between August 2012 and February 2012, we collected clinical data on patients who underwent the TAMIS procedure utilizing the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA). This included patient demographics, pathologic data, operative technique, and post-operative outcomes.

RESULTS:
Four patients successfully underwent TAMIS resection of rectal lesions. Two neoplasms were tubullovillous adenomas with high grade dyspasia. Two neoplasms were benign adenomatous polyps. All specimens had negative margins. No post-operative complications occurred. There were no conversions to open. 6month follow-up is pending.

CONCLUSIONS:
This is a technical report describing full thickness resection utilizing TAMIS. Key instrumentation included the angled tip on the hand held bovie and the Lapra-Ty in order to close sizable defects transversely. TAMIS is a feasible and cost effective alternative to transanal endoscopic microsurgery. The learning curve is comparable to TEM as the primary surgeon only had prior experience with TEM during fellowship training. Limitations include the very small sample size in this early experience.

Session: Poster Presentation

Program Number: ETP074