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[37]
that transanal LPLN dissection is feasible, safe, and promising in well-selected patients. Hayashi et al.
published that pelvic exenteration is also possible with the TAMIS platform.

TAMIS FOR EXCISION PERIRECTAL LESIONS
Excision of perirectal/pararectal lesion can be difficult even with open techniques due to the narrow space
and low accessibility. The lesion frequently needs to be excised together with the rectum. TAMIS can
been used to excise pararectal/perirectal lesions without the need for proctectomy or abdominal perineal
[38]
resection. McCarrol and Moore reported their success in excising a retro rectal cyst (tailgut cyst) in a
23-year-old patient. Furthermore, TAMIS has also been used for the excision of rectal GIST [39,40] .

TAMIS FOR COMPLICATION OF LOW RECTAL ANASTOMOSIS
Anastomotic leak after a low anterior resection can be devastating. These patients often require repeat
surgery and it is usually laparotomy. However, with high degree of suspicion and early intervention, these
[41]
complications could be handled with minimally invasive approaches as well. Chen et al. reported on
methods to manage anastomotic leaks post anterior resections using laparoscopic lavage and transanal
endoluminal repair on transanal endoscopic operation platform. Patients, in whom the anastomotic
leak was detected early (within five days), did not require conversion to laparotomy and were able to be
[42]
discharged promptly. Olavarria et al. reported a case managing presacral abscess post anastomotic leak
through three sessions of septotomies and debridement through TAMIS before successfully reversing the
[43]
ileostomy. In a completely occluded anastomosis after a low anterior resection, Bong and Lim managed
to excise the fibrotic tissue at the stenotic site and regain the continuity of the canal.

CONCLUSION
TAMIS is an evolving surgical approach and should remain an option to be considered in the management
of patients. With an increasing number of surgeons becoming familiar with TAMIS procedures, the
indication for this approach expands. However, a structured training program including proctoring to
ensure safe implementation of the procedure is necessary for beginners to obtain the necessary skills to
prevent unnecessary complications, as this is still a relatively new approach.

DECLARATIONS
Authors’ contributions
Contributed in the literature search and write up: Sriram RK
Contributed in literature search, corrections and proof reading: Chen WTL

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.