[TAMIS, transanal minimally invasive surgery]

Diseases of the lower and middle third of the rectum, the so called "no-man's territory" traditionally represent a major surgical problem. Minimally invasive surgical techniques significantly contribute to the safe and precise management of this part of the rectum. Traditional laparoscopic instruments via a specifically designed operative anoscope with single-port surgical technique are used during TAMIS (transanal endoscopic minimally invasive surgery). Since the description of the procedure in 2009 a number of case series have proven the feasibility and safety of the technique in the treatment of rectal adenomas. Furthermore, TAMIS seems to be sufficient in the primary treatment of early rectal cancers, as well. Recent studies also challenge the rigid protocols of the management of advanced rectal adenocarcinomas. Transanal wide local excision techniques (including TAMIS) with low morbidity rates seem to be effective in cases of histologically proven pCR (complete pathological response) after neoadjuvant treatment by selecting the group of patients not requiring radical TME (total mesorectal excision). Finally, TAMIS technique provide a suitable way for down-up transanal TME (TaTME), which technique is expected to potentially improve surgical grade in selected cases of advanced rectal cancer surgeries. In this paper we demonstrate our initial experiences with TAMIS at a single institution, as well as summarize the relevant literature.