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[2]
edema and hemorrhoidal thrombosis .

[45]
Barendse et al. concluded that a learning curve effect was observed in complication rates. However, a
specific case volume was not defined in this study and complication rates before and after the learning
[46]
curve were not compared. Lee et al. investigated the learning curve in a single high volume tertiary care
referral center and found that the learning curve of TAMIS for rectal neoplasms is 14-24 cases. This study
did not show a difference in complication rates before and after the learning curve.

CONCLUSION
Based on currently available clinical data, TAMIS in experienced hands, results in the high quality lo-
cal excision of early rectal tumors with low histological margin positivity in an efficient manner and low
recurrence rates in context of favourable histologic properties with an excellent morbidity profile with no
long term adverse effect on continence. The role of TAMIS for more advanced tumors and in the post-neo-
adjuvant setting needs clarification by further studies. It can also be offered as a palliative procedure to pa-
tients with metastatic disease, which would potentially avoid complications of a major surgery. TAMIS has
enabled the performance of high quality local excision of rectal lesions by many colorectal surgeons, inte-
grating transanal endoscopic surgery into mainstream practice. Currently surgeon preference and device
availability govern which platform is selected for use. As with all new techniques used in the management
of neoplastic disease, appropriate training must be ensured and the continued assessment and assurance of
oncological outcome - via databases - must be maintained.

DECLARATIONS
Authors’ contributions
Design, literature research, manuscript writing, manuscript editing, manuscript revision: Erkan A, Kelly JJ,
Monson JRT

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

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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2. Plummer JM, Leake PA, Albert MR. Recent advances in the management of rectal cancer: no surgery, minimal surgery or minimally
invasive surgery. World J Gastrointest Surg 2017;9:139-48.
3. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010;24:2200-5.