Transanal Endoscopic Platforms: TAMIS versus Rigid Platforms: Pros and Cons

Abstract

Transanal endoscopic surgery encompasses the minimally invasive surgical techniques used to operate in the rectum under magnification while maintaining pneumorectum via a resectoscope or port. The view, magnification, and surgical precision afforded by these advanced transanal techniques have resulted in excellent specimen quality and low recurrence rates, especially compared with traditional transanal surgery. For rigid platforms, the surgeon operates through a rigid 4-cm diameter steel proctoscope of varying lengths that is clamped to the operating table with an articulating arm. Transanal minimally invasive surgery (TAMIS) is a newer flexible platform using a disposable port which "hooks" into the anorectal ring to remain in place. The cost-effectiveness and versatility of the TAMIS platform have resulted in its popularity and use in more advanced applications such as transanal total mesorectal excision. Ultimately, the choice of operating platform should be based on surgeon preference, patient characteristics, availability, and cost. The pros and cons of each platform will be discussed in this article.

Keywords: TAMIS; TEM; TEO; transanal endoscopic surgery.

Fig. 1

Transanal endoscopic microsurgery, Richard Wolf GmbH, Germany.

Fig. 2

Transanal endoscopic operations (TEO), Karl Storz SE & Co. KG, Germany.

Fig. 3

Schematic representation of dimensions and instrument working angles of transanal endoscopic microsurgery (TEM) endoscope and transanal minimally invasive surgery (TAMIS). (Reprinted with permission from Burke and Albert. 9 )

Fig. 4

GelPOINT Path TAMIS port, Applied Medical, Rancho Santa Margarita, CA.