Transanal Minimally Invasive Surgery (TAMIS) is a specialised minimally invasive approach for removing benign polyps and early stage cancerous tumours within the rectum and lower sigmoid colon.
TAMIS uses the anal opening rather than an incision in the abdominal wall which means it is less invasive. During TAMIS, a specialised laparoscopic surgery port is placed into the anus. The laparoscope and instruments required to carry out the procedure are passed through the port to the rectum, where the surgeon removes the polyp or tumour. Once the lesion is removed, the defect in the rectum is usually sutured closed.
TAMIS can be performed using a variety of surgical platforms. Generically these platforms can be classified as either fixed or mobile and are usually named by the manufacturer. Common platforms used include the Transanal Endscopic Operating TEO system which is a fixed platform; the Transanal Endoscopic Surgery TEM fixed platform; and the GelPOINT mobile platform. The key benefit of TAMIS is that it can enable surgeons to avoid having to perform major abdominal surgery and remove a section of the patient’s rectum for early cancers.
Potential benefits
Research has shown TAMIS to offer many advantages over more major traditional surgical techniques. These include:
- decreased post-operative pain
- fewer complications
- faster recovery times
- shorter hospital stay.
Choice of platform?
While TEM has been in use for the last 30 years or so the relative high cost of the equipment needed meant that it was not available to many surgeons.
More recent platforms which have been available over the past 10 years can incorporate some standard laparoscopic instruments and have helped reduce the equipment cost and have resulted in TAMIS becoming a more widely available surgical technique.
For neoplastic disease TAMIS is currently only recommended with curative intent for patients with pre-cancerous polyps; T1 rectal cancers; or small T2 rectal cancers usually when in the setting of clinical trials. It is not suitable for patients at a more advanced stage, as the technique does not allow for surrounding lymph nodes in the adjacent fatty tissue called the mesorectum to be adequately assessed and treated for the spread of cancer.
