Transanal minimal invasive surgery for rectal lesions: should the defect be closed?

Area of Science:

• Colorectal surgery
• Minimally invasive surgery
• Surgical oncology

Background:

• Transanal minimal invasive surgery (TAMIS) is gaining traction for rectal lesions, but standardization and optimal techniques remain under investigation.
• Evaluating peri-operative complications and long-term functional outcomes is crucial for widespread adoption.

Purpose of the Study:

• To assess peri-operative complications associated with TAMIS.
• To evaluate long-term functional outcomes, specifically continence, after TAMIS.
• To determine if closure of the rectal defect is necessary after TAMIS.

Main Methods:

• A consecutive series of patients undergoing TAMIS using a single-incision laparoscopic surgery (SILS) port and standard laparoscopic instruments were studied across three centers.
• Data collected included operative times, complication rates, and functional outcomes.
• Rectal defects were closed in 53% of cases, using either interrupted or running sutures.

Main Results:

• Seventy-five patients with benign or low-risk malignant rectal lesions were included.
• Intra-operative complications occurred in 8% of patients, and postoperative morbidity was 19%, with no significant difference in complication rates based on rectal defect closure.
• At a median follow-up of 12.8 months, continence was normal, with no compromise observed whether the defect was closed or left open.

Conclusions:

• Transanal rectal resection using a SILS port and laparoscopic instruments is a safe and efficient procedure.
• The rectal defect following TAMIS can be safely left open without negatively impacting long-term continence.
• TAMIS offers a viable option for rectal lesion resection with favorable functional outcomes.