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. 2018:52:11-15.
doi: 10.1016/j.ijscr.2018.09.029. Epub 2018 Sep 29.

Trans-anal minimally invasive surgery: A new technique to avoid peritoneal entry

Anne-Marie Dufresne  1 , Rebecca Withers  2 , Jonathan Ramkumar  2 , Shawn Mackenzie  2 , George Melich  2 , Elena Vikis  2
Affiliations

Trans-anal minimally invasive surgery: A new technique to avoid peritoneal entry

Anne-Marie Dufresne et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Transanal minimally invasive surgery (TAMIS) is a valuable surgical option for removal of rectal polyps and early rectal cancers. A potential complication of this technique is abdominal entry if the lesion is located above the peritoneal reflection. We present the first case series describing the use of a laparoscopic stapling device to remove a sessile lesion, and seal the resulting defect simultaneously with full thickness excision of the rectal lesion, avoiding abdominal entry.

Presentation of cases: Five patients with rectal lesions between 8 and 14 cm from the anal verge are described in this case series. Each underwent a stapled-TAMIS procedure as the lesion was suspected to be above the peritoneal reflection. The goal specimen was achieved in each procedure.

Discussion: This article demonstrates the feasibility of a novel technique to remove sessile polyps in the upper rectum using laparoscopic staplers trans-anally through the TAMIS port. More studies and long-term follow-up are needed to evaluate the oncologic outcomes including the recurrence rate for those lesions removed with a stapler.

Conclusion: For rectal lesions suspected to be above the peritoneal reflection, a stapled resection through a TAMIS port could prove be a valuable addition to the standard excisional approach to TAMIS.

Keywords: Abdominal entry; Peritoneal violation; Stapler; TAMIS.

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Figures

Fig. 1
Fig. 1
Intraoperative setup for TAMIS, including the AirSeal device.
Fig. 2
Fig. 2
Intraoperative view of the rectal polyp being stapled with a laparoscopic Echelon stapler.
Fig. 3
Fig. 3
End result of the closure of the rectal defect with a laparoscopic stapler.
Fig. 4
Fig. 4
Flexible sigmoidoscopy three months after a stapled TAMIS.
Fig. 5
Fig. 5
Flexible sigmoidoscopy three months after a stapled TAMIS.
See this image and copyright information in PMC

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