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

Anne-Marie Dufresne; Rebecca Withers; Jonathan Ramkumar; Shawn Mackenzie; George Melich; Elena Vikis

doi:10.1016/j.ijscr.2018.09.029

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

Int J Surg Case Rep. 2018:52:11-15. doi: 10.1016/j.ijscr.2018.09.029. Epub 2018 Sep 29.

Authors

Anne-Marie Dufresne¹, Rebecca Withers², Jonathan Ramkumar², Shawn Mackenzie², George Melich², Elena Vikis²

Affiliations

¹ Royal Columbian Hospital, Department of Surgery, 330 E Columbia St., New Westminster, BC, V3L 3W7, Canada; University of British Columbia, Faculty of Medicine, Department of Surgery, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: annemarie.dufresne@hotmail.com.
² Royal Columbian Hospital, Department of Surgery, 330 E Columbia St., New Westminster, BC, V3L 3W7, Canada; University of British Columbia, Faculty of Medicine, Department of Surgery, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.

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.