Management of Various Rectal Lesions by Using Transanal Minimally Invasive Surgery

Minimally invasive surgery is already well-established in the field colorectal surgery, thanks to the good oncological outcomes and early post-operative recovery in cases of early rectal tumors. transanal minimally invasive surgery (TAMIS) is becoming popular in managing benign and early malignant rectal lesions. The purpose of this study is to discuss feasibility of TAMIS in managing benign and early malignant rectal tumors, rectal strictures, and as a combined technique in procedures concerning chronic ulcerative colitis, FAP, and adenoma. A total of 12 patients (3 chronic ulcerative colitis, 2 GISTs, 2 stage I rectal cancer, 2 rectal adenoma, 2 anastomotic rectal stenosis, and 1 FAP) underwent surgery by using the technique of TAMIS. Restorative proctocolectomy with ileal pouch anal anastomosis, for chronic UC and FAP, en bloc excision for rectal GIST and T1 adenocarcinoma, radial incision and cutting for rectal strictures, and submucosal dissection of adenoma by TAMIS alone or combined with ESD were performed. GelPOINT path (Applied Medical) was used for transanal access. There were no intra-operative and immediate post-operative complications. The mean operation time was 81.2 min, ranging from 20 to 164 min. One patient with GIST had positive margin on pathology, which was re-excised using TAMIS. The patient with preoperative diagnosis of clinical T1 tubular adenocarcinoma revealed T3 tumor with positive lymph node on final pathology and was further managed with adjuvant chemo-radiotherapy. Thus, TAMIS is a safe and feasible surgical technique for minimally invasive management of various rectal lesions.