Transanal Minimally Invasive Surgery for Rectal Cancer

 

 

Sandy Fang says TAMIS offers many of the advantages of TEM without the need for specialized, expensive instruments.

Transanal endoscopic microsurgery (TEM) has been used for some 30 years as an alternative to abdominal surgery for large rectal polyps, but the difficulty of setting up the instrumentation and the cost of the equipment left many surgeons looking for other options. One is transanal minimally invasive surgery (TAMIS), which was introduced four years ago.

TAMIS offers many of the advantages of TEM without the need for specialized, expensive instruments, says surgeon Sandy Fang, who performs the procedure and is the director of the High Resolution Anoscopy Clinic at Johns Hopkins. Using standard laparoscopic instruments, surgeons can remove a polyp or superficial lesion through the anus, without making an incision.

During TAMIS, a specialized laparoscopic surgery port is placed into the anus. The laparoscope and needed instruments are passed through the port to the rectum, where the surgeon removes the polyp.Once the lesion is removed, the hole in the rectum is sutured closed.

“TAMIS allows us to remove polyps that are too large or too flat to be removed with a colonoscope or flexible sigmoidoscopy without removing the rectum,” says Fang. Rectal resection is associated with a number of adverse effects, including fecal incontinence, urinary issues, and sexual dysfunction, and requires several days in the hospital, making TAMIS an important option for patients who have benign rectal polyps and for a highly selected group among the 40,000 people who develop rectal cancer each year.

“The biggest drawback of TAMIS is that lymph nodes cannot be assessed for cancer spread, so the procedure is only used for patients with very early stage rectal cancer,” says Fang.

Patients who have TAMIS stay in the hospital overnight to be monitored for complications from making a perforation into the rectum during the procedure, though it is a rare occurrence.

If the cancer has advanced beyond the earliest stage, or if any lymph node involvement is suspected, then a rectal resection should be performed. Recovery is significantly better after TAMIS compared with traditional surgery, with shorter hospital stays and fewer complications.

To refer a patient: 443-997-1508