TAMIS Surgery and Other Options

WHAT IS TAMIS?

Transanal minimally invasive surgery (TAMIS) is a specialized minimally invasive approach to removing benign polyps and some cancerous tumors within the rectum and lower sigmoid colon. The benefit of TAMIS is that it is considered an organ-sparing procedure, and is performed entirely through the body’s natural opening, requiring no skin incisions to gain access to a polyp or tumor. This scar-free recovery provides a quick return to normal bowel function.

Unlike traditional surgery where a major portion of the large intestine is removed, with TAMIS your surgeon will precisely remove the diseased tissue, leaving the rest of your natural bowel lumen intact to function normally.

Traditional surgery often requires a large incision and a hospital stay ranging from a few days to more than a week. A TAMIS procedure may only require an overnight stay in the hospital or can be performed as an outpatient procedure, often permitting patients an immediate return to an active lifestyle. If you have been diagnosed with a rectal tumor, it’s important to talk to your doctor about the treatment options for your specific condition to determine if TAMIS or another procedure is recommended for you.

Incision Diagram for TAMIS Surgery Options

WHAT TO EXPECT WITH TAMIS

PRIOR TO SURGERY

Your surgeon may prescribe a bowel prep regimen to cleanse your colon in preparation for the procedure. The process involves the removal of waste present in the colon and rectum in order to reduce risk of infection and ensure a clear view for the surgeon during the procedure.

DAY OF SURGERY

TAMIS is performed under general anesthesia, so you will be asleep throughout the surgery.
A specialized TAMIS device is placed inside the anal canal to provide the surgeon access to the rectum.
The rectum is inflated with carbon dioxide gas (similar to a colonoscopy) which offers the surgeon visibility and optimal working space.
A high-definition camera and specialized laparoscopic instruments are placed through the TAMIS device, allowing the surgeon to operate with the utmost precision.
The tumor is removed and the rectum is repaired internally to allow the wall of the rectum to heal.
Once the surgery is complete, the TAMIS device is removed and the gas is evacuated.

AFTER SURGERY

TAMIS patients are typically discharged within 24 hours of the operation with no restrictions and little to no pain. Patients will have no scars on their skin as the only incisions are inside the rectum.

PRIOR TO SURGERY

Your surgeon may prescribe a bowel prep regimen to cleanse your colon in preparation for the procedure. The process involves the removal of waste present in the colon and rectum in order to reduce risk of infection and ensure a clear view for the surgeon during the procedure.
DAY OF SURGERY
- TAMIS is performed under general anesthesia, so you will be asleep throughout the surgery.
- A specialized TAMIS device is placed inside the anal canal to provide the surgeon access to the rectum.
- The rectum is inflated with carbon dioxide gas (similar to a colonoscopy) which offers the surgeon visibility and an optimal working space.
- A high-definition camera and specialized laparoscopic instruments are placed through the TAMIS device, allowing the surgeon to operate with the utmost precision.
- The tumor is removed and the rectum is repaired internally to allow the wall of the rectum to heal.
- Once the surgery is complete, the TAMIS device is removed and the gas is evacuated.
AFTER SURGERY

TAMIS patients are typically discharged within 24 hours of the operation with no restrictions and little to no pain. Patients will have no scars on their skin as the only incisions are inside the rectum.

OVERVIEW OF COMMON SURGICAL OPTIONS

If your doctor recommends surgery to remove a rectal tumor, you may be qualified for more than one type of procedure. Treatment options depend on a patient’s health and specific condition, including stage of tumor. Your surgeon may suggest a minimally invasive approach, which may shorten the post-surgical hospital stay and allow a quicker recovery compared to traditional surgical techniques. While not all conditions are amenable to a minimally invasive approach, advances in technology and surgical technique are allowing more patients to receive minimally invasive procedures. Below are common procedures your surgeon may offer to treat your condition. Remember, TAMIS poses all the same potential risks as other surgical procedures. It’s important to discuss your diagnosis with your healthcare provider to understand whether you are a candidate for a minimally invasive procedure.

POLYPECTOMY:

Polypectomy may be performed during a colonoscopy to remove small growths from the wall of the colon and rectum. Commonly an instrument called a snare is used to remove the polyp. This is referred to as snare polypectomy. Sometimes follow-up surgery is recommended to remove any residual polyp. Surgery may also be recommended for polyps too large to remove during colonoscopy.

TAMIS (LOCAL EXCISION):

With a local excision, the tumor and a small amount of the surrounding tissue are removed from the rectum. The rest of the rectum is left intact. The surgeon accesses the rectum through the patient’s natural entry port (transanally), either by TAMIS or a similar method. The benefits of a local excision are that there are no skin incisions required, and the healthy part of the rectum is spared. Local excision, including TAMIS, is considered an organ-sparing procedure.

Local excision is commonly performed for benign tumors which are too large to be removed during colonoscopy. Local excision may also be effective for some early cancers (T1, T2), where the chance of recurrence and metastasis is typically low. Local excision is not an effective treatment for advanced cancers (T3, T4), though may be employed if a patient declines, or is not healthy enough, to undergo more complex surgery. It’s important to talk to your doctor to determine if TAMIS or another procedure is recommended to treat your specific condition.

Local Excision Diagram for TAMIS Surgery

LOW ANTERIOR RESECTION (LAR):

A low anterior resection (LAR) may be recommended for patients with a tumor in the upper (proximal) two-thirds of the rectum. LAR may also be recommended for patients with a tumor in the lower (distal) one-third of the rectum. The surgery entails the removal of all or a portion of the rectum, the sigmoid colon, and part of the descending colon.

If the entire rectum is removed, this may be called a proctectomy.
Often the tissue surrounding the rectum, called the mesorectum, is also removed. The mesorectum contains lymph nodes that most commonly contain metastases. Removal of the entire mesorectum, called a total mesorectal excision (TME), greatly reduces the chance of recurrence.
After the diseased tissue is removed, the colon is reconnected to the anus or the rectal stump surgically, which is referred to as an anastomosis. This allows the patient to resume normal removal of waste.
A small pouch similar to the rectum may be created to function as a storage space for waste matter. This pouch is made by folding back a short segment of colon to form a J-pouch. A pouch can also be made by enlarging a segment of the colon, known as a coloplasty.
A temporary ileostomy is often created to allow the anastomosis and/or new storage space to heal. The ileostomy diverts the small intestine through a surgically created opening in the abdominal wall, called a stoma. A special bag is attached to the stoma to collect waste that would normally pass through the large intestine. The ileostomy is typically in place for a short period of time (several weeks to several months). Once the anastomosis has healed, a second operation is performed to reverse the ileostomy so the patient can return to normal bowel function. This procedure typically involves less pain and a shorter recovery time.

Abdominoperineal Resection Diagram for TAMIS Surgery

ABDOMINOPERINEAL RESECTION (APR):

An abdominoperineal resection (APR) may be performed for tumors that have spread to the lowest area of the rectum and/or anus. An APR involves removal of part of the sigmoid colon, the rectum and the anus. Because the anus is removed, the removal of waste requires a stoma, which reroutes the large intestine through the abdominal wall and outside the body. A special bag must be worn permanently to collect waste flow from the body. This is referred to as a permanent colostomy.