Transanal minimally invasive surgery (TAMIS): Pros and cons of this evolving procedure

Transanal endoscopic surgery (TES) enables the intra-luminal excision of rectal lesions with specialized equipment that maintains a stable pneumorectum and enables magnified visualization of target lesions along with the capacity for using precise instrumentation for tissue resection and re-apposition. The requirement for generalizable, cost-effective access modalities for the local excision of rectal lesions combined with the existing skill set applied to single-incision laparoscopic surgery led to transanal minimally invasive surgery (TAMIS). There currently exists global experience with 5 different TAMIS platforms. TAMIS has a short learning curve, reduced device set up time, flexibility in instrument use, and versatility in application. By comparison, however, its close relation TEM can access more proximal lesions, has specialized insufflators, which permits a more stable pneumorectum, and has a significantly greater duration of patient follow-up in the surgical literature. Overall, TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons. As TAMIS becomes more broadly utilized, the acquisition of appropriate training must be ensured, and the continued assessment and assurance of oncological outcome must be maintained. (C) 2015 Elsevier Inc. All rights reserved.