title: Feasibility of transanal minimally invasive surgery for mid-rectal lesions.
abstract: BACKGROUND
  Transanal minimally invasive surgery (TAMIS) has emerged as an alternative to transanal endoscopic microsurgery. We assessed the feasibility of TAMIS for lesions located in the mid rectum.
  
  
  METHODS
  From July 2010 to October 2011, 16 consecutive patients with rectal pathology underwent TAMIS. After a single-incision laparoscopic surgery port was introduced into the anal canal, pneumorectum was established with a laparoscopic device, followed by transanal excision with conventional laparoscopic instruments, including graspers, monopolar electrocautery, and needle drivers. Clinicopathological findings, surgical procedure results, and perioperative outcomes were determined prospectively.
  
  
  RESULTS
  Of the 16 patients, 11 had rectal cancers (3 T1 lesions and 8 after preoperative chemoradiotherapy), 4 had neuroendocrine tumors, and 1 had a mucocele. The median length of the lesions from anal verge was 7.5 cm (range 4-10 cm). All procedures were completed laparoscopically without conversion to conventional transanal approach. The median operating time was 86 min (range 33-160 min), and the median estimated blood loss was 15 ml (range 0-150 ml) with no patient requiring intraoperative transfusions. There was no surgical morbidity or mortality, but one patient died during follow-up due to synchronous advanced gastric cancer. The median postoperative hospital stay was 3 days (range 2-6 days).
  
  
  CONCLUSIONS
  TAMIS seems to be a feasible and safe treatment option for lesions located in the mid rectum.
authors.affiliation: Departments of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, Korea. sblim@amc.seoul.kr
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.forename: Seok-In
authors.initials: SI
authors.lastname: Seo
authors.forename: Jong Lyul
authors.initials: JL
authors.lastname: Lee
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Kwak
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Jang
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*