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Surgical Innovation
November 18, 2020

Transanal Minimally Invasive Surgery

Author Affiliations
  • 1UCF College of Medicine, Orlando, Florida
JAMA Surg. 2021;156(1):92-93. doi:10.1001/jamasurg.2020.4994

Transanal minimally invasive surgery (TAMIS) was developed in 2009 as a method to locally excise premalignant and select malignant lesions of the rectum with curative intent.1 The technique is an extrapolation of single-port laparoscopy. TAMIS uses an access platform that creates a gas-tight seal when properly seated within the anorectum. This allows for the delivery of CO2 using a laparoscopic insufflator, necessary for creating a stable endoluminal operating environment. With TAMIS, basic laparoscopic instruments are deployed transanally (via the access platform) to carry out the excision; a self-locking suture can be used to facilitate defect closure, if needed. This approach to local excision (LE) provides an alternative to traditional techniques, such as the Parks transanal excision (TAE), allowing the surgeon to operate with higher reach since the rectal lumen is distended. Instrument triangulation is feasible and the surgical field can be viewed in 360° with high-definition optics. The predecessor to TAMIS was transanal endoscopic mircrosurgery (TEM), developed in 1984.2

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