Transanal Minimally Invasive Surgery: A Useful Technique That Continues to Evolve

Colorectal cancer remains the 3rd most common cancer diagnosed among men and women in the United States. With improved screening, premalignant rectal lesions and rectal cancers are being detected at earlier stages. In addition, the use of neoadjuvant chemo- and radiotherapy has led to downstaging of larger lesions. There is growing interest among colorectal surgeons in local excision with organ preservation for patients with rectal cancer. There are multiple platforms for local excision of rectal cancers, including transanal excision (TAE), transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS). TAMIS was developed as an affordable platform that uses conventional laparoscopic equipment familiar to many colorectal surgeons. TAMIS allows for full-thickness benign or malignant lesion excision in any quadrant without the need for patient repositioning. The literature has shown that, for appropriately selected patients, TAMIS provides superior excision quality compared to TAE. Furthermore, TAMIS has oncologic outcomes equivalent to TEM at a fraction of the cost. Recently, robotic TAMIS has been introduced, which takes advantage of the articulating instruments of the robotic platform without the need for a skilled assistant. This article will cover multiple technical aspects for TAMIS including patient selection and preparation, technical tips for successful excision and defect closure, and recent advances, including robotic TAMIS.