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Video

Session: Ongoing Videos

VM45 - Cutting Beyond the Verge: Stapling Technique to Facilitate TAMIS

ONGOING VIDEOS
Location: San Diego Convention Center, ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • Evan D. Adams, MD (he/him/his)

    Fellow
    The Ohio State University
    Columbus, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Kent J. Peterson, MD

    Fellow
    Ohio State University
    Columbus, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Melik K. Aktas, MD (he/him/his)

    Research Fellow
    The Ohio State University
    Columbus, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Syed Husain, MD

    Professor
    The Ohio State University
    Ohio State University
    Columbus, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Evan D. Adams, MD: This individual has no financial relationships with ineligible companies.
Kent J. Peterson, MD: This individual has no financial relationships with ineligible companies.
Melik K. Aktas, MD: This individual has no financial relationships with ineligible companies.
Syed Husain, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Transanal minimally invasive surgery (TAMIS) combines laparoscopic principles with pneumorectum to address intraluminal pathology. This approach avoids the morbidity associated with surgery, while providing useful diagnostic information. If the disease is limited to the mucosa, it can represent therapeutic resection among select patients.

Proximal location and bulky lesions can be particularly challenging with traditional electrocautery dissection, as these conditions increase the risk ofperitoneal entry, inadvertent injury to adjacent structures, and positive margins. We have found stapled technology to be particularly useful in these circumstances and present a video highlighting the benefits of this approach.

Methods/Interventions: We present a technical video description of our set-up and technical principles for a stapled TAMIS. Important points include a preoperative bowel preparation and lithotomy positioning. Key equipment includes a 45-degree endoscope, two 5mm and one 12mm 10cm long trocars. We recommend utilizing an articulating stapler

Results/Outcomes: The case presented is a 65 year-old male was referred for a rectal polyp not amenable to endoscopic resection on diagnostic colonoscopy. Initial forceps biopsy demonstrated a tubulovillous adenoma with high grade dysplasia. Flexible sigmoidoscopy in the office demonstrated a left posterior fungating mass at 12 – 15cm. He was taken for a stapled TAMIS, which was performed on an outpatient basis with a single resection specimen. Pathology demonstrated a pT3Nx lesion. Following staging and multidisciplinary discussion, he will undergo surgery for a T3N0 upper rectal cancer.

Conclusion/Discussion: Stapled TAMIS is technically feasible and may be particularly beneficial for proximal and bulky lesions. This technique may reduce peritoneal
entry and inadvertent injury compared with electrocautery-based techniques.