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Transanal Minimally Invasive Surgery: A Multi-Purpose Operation.

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TransAnal Minimally Invasive Surgery (TAMIS) offers a versatile approach for various rectal conditions, including benign diseases and early cancers. This technique provides ergonomic benefits and improved visualization for complex procedures like Transanal total mesorectal excision (TaTME).

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • Minimally Invasive Colorectal Surgery (MICS) is advancing, with TransAnal Minimally Invasive Surgery (TAMIS) emerging as a key development.
  • TAMIS utilizes the anus as a natural orifice for minimally invasive procedures, expanding treatment options for rectal conditions.
  • Transanal total mesorectal excision (TaTME) is a prominent application of TAMIS, alongside treatments for benign diseases and early rectal adenocarcinoma.

Purpose of the Study:

  • To present the author's experience and evaluate the efficacy of TransAnal Minimally Invasive Surgery (TAMIS) as a multi-purpose surgical technique.
  • To assess TAMIS applications in treating a range of benign rectal conditions and early-stage rectal cancers.
  • To evaluate the feasibility and outcomes of Transanal total mesorectal excision (TaTME) performed using TAMIS principles.

Main Methods:

  • A retrospective analysis of 66 patients undergoing TAMIS between January 2015 and May 2019.
  • Group 1 (36 patients) underwent TAMIS for benign diseases (anastomotic leakage, stenosis, ulcus, intussusception) and early malignant polyps.
  • Group 2 (30 patients) underwent Transanal total mesorectal excision (TaTME), with variations in accompanying abdominal laparoscopic techniques.

Main Results:

  • Mean operative times varied significantly based on the procedure, with TaTME averaging 197.1 minutes and various TAMIS procedures ranging from 20 to 180 minutes.
  • Mean operative bleeding was lower in Group 1 (14.3 ml) compared to Group 2 (57.0 ml).
  • Early complication rates were 27.7% for Group 1 and 40% for Group 2; late complication rates were 8.3% and 10%, respectively.

Conclusions:

  • TransAnal Minimally Invasive Surgery (TAMIS) is a versatile technique suitable for treating various benign rectal conditions, including anastomotic complications and rectal stenosis.
  • The technique facilitates dissection in challenging planes not easily accessible via abdominal approaches and is effective for early rectal polyp removal and TaTME.
  • TAMIS offers ergonomic advantages, utilizes reusable materials, provides magnified visualization, and enables intraluminal suturing, enhancing surgical precision.