Published in:
01-04-2013 | The Last Image
Anyone for TAMIS?
Published in: Techniques in Coloproctology | Issue 2/2013
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A 64-year old lady underwent a rectal polypectomy for a postero-lateral polyp at 5 cm from the anal verge. Histology demonstrated a focus of adenocarcinoma (Haggit level 3). She went on to undergo excision of the polyp scar using Trans-Anal Minimally Invasive Surgery (TAMIS), a novel technique dubbed a hybrid between Transanal Endoscopic Microsurgery (TEM) and single port laparoscopy (Figs. 1, 2, 3–4). Mucosal resection of the scar was straightforward (Figs. 5, 6, 7–8), and the patient made an uneventful recovery. Histology demonstrated no further foci of adenocarcinoma.
Fig. 1
The TAMIS kit (Applied Medical, £349) comprises a 4-cm access channel with anal introducer, a gel cap and three 10-mm ports
Fig. 2
The access channel is sutured to the perianal skin for the duration of the procedure
Figs. 3, 4
The ports are inserted through the gel cap. Total set-up time is less than 10 min
Fig. 5
A conventional 10-mm laparoscopic camera and 5-mm laparoscopic instruments are used
Fig. 6
The polyp scar is marked with hook diathermy prior to the incision
Figs. 7, 8
The scar is resected in the sub-mucosal plane, using hook diathermy and gentle tension with atraumatic graspers
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