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applications, with increasing use in benign pathologies including repair of recto-urethral fistula, ligation
of distal rectal haemorrhage, resection of tail-gut/duplication cysts, removal of rectal foreign body [62,63] .
Where uncertainty or complexity exists pre-operative planning and rehearsal with imaging adjuncts has
[64]
been shown to be beneficial and can aid guide surgery in complex cases . The utility of novel imaging
techniques (e.g., 3D imaging, stereotactic surgery) in preoperative surgical planning and intraoperative
mapping has been recently showed both in benign conditions and cancer [65-69] . This might allow a truly
personalized approach with TAMIS proctectomy, where the extent of the TME can be adapted to disease
features and patient needs.

Long-term oncologic outcomes and controlled trials of the technique are needed to guide further use in
[70]
clinical practice. As the interest and uptake of this exciting new platform continues to rise exponentially ,
further prospective and comparative studies will be beneficial in evaluating this platform and shaping its
role. Together with following international guidelines and recommendations, surgeons willing to offer their
patients the option for TAMIS need to follow the training pathways and accreditation which have been set
for the safe implementation of the technique into clinical practice. Under this light, a critical role is also
played by honest participation into International registries, which can capture a wider, real-life perspec-
tive about performance, safety and patient-relevant outcomes of surgical procedures. Consensus exercises
will also be useful in defining patient selection criteria and indications for its use in the armamentarium of
colorectal surgery.

DECLARATIONS
Authors’ contributions
Conceptualised the topic and oversaw direction of narrative: Warusavitarne J
Drafted the manuscript: Adegbola SO
Performed literature review, prepared the manuscript: Adegbola SO, Sahnan K, Pellino G
Revised the manuscript critically, prepared the final version: all authors

Availability of Data and Materials
Not applicable.

Financial support and sponsorship
Kapil Sahnan is supported by a Royal College of Surgeons of England Research Scholarship. The other au-
thors have no conflict of interests or financial ties to disclose.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

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