Expanding the indications for transanal endoscopic surgery

During the last several years a numerous variety of platforms have been described for transanal endoscopic surgery using both rigid and flexible platforms; under the global heading of transanal endoscopic surgery include transanal endoscopic microsurgery, transanal endoscopic operating, and transanal minimally invasive surgery. While the majority of reports describe these techniques being used to resect neoplastic lesions and/or remove the rectum in its entirety, other uses have developed. Bemelman as the senior author of a publication in Surgical Endoscopy described the use of transanal endoscopic surgery and in particular transanal minimally invasive surgery (TAMIS) as an access modality for patients requiring re-operative pelvic surgery. They described a group of 17 patients who had previously undergone either low anterior resection with colorectal or coloanal anastomosis or ileal pouch anal anastomosis. They successfully undertook the TAMIS technique in 14 of the 17 patients while 3 patients required a completion proctectomy with end stoma. The authors grouped their indications into anastomotic problems and pouch problems. Ten of the 13 patients with anastomotic problems had chronic presacral sinuses secondary to anastomotic leaks. Four patients had a heterogeneous variety of pouch related problems. The authors successfully completed TAMIS with successful meeting with abdominal aspect in 15 patients encountering only one intraoperative complication. All of the 14 patients in whom continuity was restored with the TAMIS approach underwent a hand-sewn anastomosis. Two patients (14%) developed an anastomotic leak, five patients (29%) were readmitted, and 4 patients (24%) developed a pelvic abscess requiring re-intervention. One patient developed a urethral stenosis. Ultimately 71% of patients had continuity restored at the 6 month follow-up. The authors certainly challenge our ability to push the envelope with transanal endoscopic surgical methods.