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Sriram et al . Mini-invasive Surg 2020;4:19 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.40

Review Open Access

Transanal minimally invasive surgery: how can it

help us?

Ratha Krishnan Sriram, William Tzu-Liang Chen

Department of Colorectal Surgery, China Medical University Hsinchu Hospital, Zhubei City, Hsinchu County 30272, Taiwan.
Correspondence to: Prof. William Tzu-Liang Chen, Department of Colorectal Surgery, China Medical University Hsinchu
Hospital, No 199, Sec 1, Xinglong Road, Zhubei City, Hsinchu County 30272, Taiwan. E-mail: golfoma22@gmail.com
How to cite this article: Sriram RK, Chen WTL. Transanal minimally invasive surgery: how can it help us? Mini-invasive Surg
2020;4:19. http://dx.doi.org/10.20517/2574-1225.2019.40
Received: 9 Oct 2019 First Decision: 16 Dec 2019 Revised: 31 Dec 2019 Accepted: 16 Jan 2020 Published: 13 Mar 2020

Science Editor: Giulio Belli Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Transanal surgery has evolved significantly in the past few decades. With the technological advancements of endoscopic
systems, minimally invasive approaches in transanal surgeries are quickly increasing in popularity. Transanal endoscopic
microsurgery was developed initially with subsequent transanal minimally invasive surgery (TAMIS) being introduced
as an alternative in 2009. Over the past decade, more and more papers have been published on TAMIS, regarding
the management of benign/malignant rectal lesions as well as repair of anastomotic leaks, anastomotic strictures,
rectovaginal/rectourethral fistula, etc. This review details the progress of transanal surgery and the use of TAMIS in
different scenarios.

Keywords: Transanal minimally invasive surgery, transanal surgery

INTRODUCTION
Previously, rectal lesions, both benign and malignancies, were initially managed with local transanal
excision (TAE) with the assistance of anal retractors (Park’s transanal technique). This approach has its
limitations, such as poor visibility, fragmented specimens, and difficulties in accessing proximal two-
[1]
thirds lesions . Subsequently, transanal endoscopic microsurgery (TEM) was introduced to overcome
the drawbacks of TAE. TEM has shown to be superior to TAE, resulting in less fragmentation and
better quality of excision. TEM also shows lower incidences of local recurrence in well-selected T1 rectal
[2,3]
cancer . However, this technique was not well adopted due to its high cost and steep learning curve.
Transanal minimally invasive surgery (TAMIS) was introduced in 2009 and in the span of a few years
gained multiple international experiences. TAMIS is defined as the use of any multichannel port

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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