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. 2013 Sep;27(9):3478-84.
doi: 10.1007/s00464-013-2889-4. Epub 2013 Mar 14.

TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series

Elisabeth C McLemore  1 , Alisa M Coker, Bikash Devaraj, Jeffrey Chakedis, Ali Maawy, Tazo Inui, Mark A Talamini, Santiago Horgan, Michael R Peterson, Patricia Sylla, Sonia Ramamoorthy
Affiliations

TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series

Elisabeth C McLemore et al. Surg Endosc. 2013 Sep.

Abstract

Background: To demonstrate the feasibility of an innovative technique for the surgical management of rectal cancer, we performed transanal minimally invasive surgery assisted low anterior resection with total mesorectal excision (TAMIS-assisted LAR with TME) in a cadaver model. Transanal LAR via natural orifice transluminal endoscopic surgery has been reported in cadaveric series using rigid transanal platforms. This procedure has not been described using a combination of a single incision laparoscopy and TAMIS transanal endoscopic platform. We describe the first cadaveric series of TAMIS-assisted LAR with TME.

Methods: TAMIS-assisted LAR with TME was successfully performed in five fresh human cadavers. The procedure was performed using the mini-Gelpoint single incision platform and the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA). The variables recorded were age, body mass index (BMI), operative time, complications, and specimen length. The grade of the TME was determined by evaluation of the specimen by photo documentation by a gastrointestinal pathologist.

Results: All cadavers were male with a mean age of 71 ± 8 years and mean BMI of 28 ± 3 kg/m(2). The mean operative time was 200 ± 55 min (range 128-249 min). The quality of the TME was grade I (complete) with intact mesorectum in all five cases. The mean specimen length was 36.8 ± 3.4 cm.

Conclusions: TAMIS-assisted LAR with TME was feasible. A high-quality TME can be achieved using this innovative technique. Transanal endoscopic total mesorectal dissection may revolutionize the surgical management of rectal cancer. However, multicenter clinical trials are needed to further evaluate the oncologic safety and surgical outcomes of transanal endoscopic TME using various platforms before widespread application of this new technique.

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Conflict of interest statement

Elisabeth C. McLemore, MD is a consultant and an instructor for industry sponsored educational events for Applied Medical and Ethicon Endo-Surgery.

Alisa Coker, MD has no conflicts of interest or financial ties to disclose. Dr. Coker is a minimally invasive surgery research resident under the mentorship of Dr. Horgan, Talamini, and Dr. McLemore.

Bikash Devaraj, MD has no conflicts of interest or financial ties to disclose.

Jeffrey Chakedis, MD has no conflicts of interest or financial ties to disclose.

Ali Maawy, MD has no conflicts of interest or financial ties to disclose.

Tazo Inui, MD has no conflicts of interest or financial ties to disclose.

Mark A. Talamini, MD serves on the advisory board and is a consultant for Olympus. Dr. Talamini is also a consultant and an instructor for industry sponsored educational events for Ethicon Endo-Surgery. Educational grants from Ethicon Endosurgery and Olympus provide additional funding to support research, education and training conducted at the UC San Diego Center for the Future of Surgery.

Santiago Horgan, MD serves on the advisory board and is a consultant for Olympus. Dr. Horgan is also a consultant and an instructor for industry sponsored educational events for Ethicon Endo-Surgery. Educational grants from Ethicon Endo-Surgery and Olympus provide additional funding to support research, education and training conducted at the UC San Diego Center for the Future of Surgery.

Mike Peterson, MD

Patricia Sylla, MD is a consultant and an instructor for industry sponsored educational events for Applied Medical and …

Sonia Ramamoorthy, MD is a consultant and an instructor for industry sponsored educational events for Applied Medical and Ethicon Endo-Surgery.

Figures

Figure 1
Figure 1
Abdominal Port Placement
Figure 2
Figure 2
Combined Set Up
Figure 3
Figure 3
Specimen
See this image and copyright information in PMC

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