title: TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series.
abstract: BACKGROUND
  To demonstrate the feasibility of an innovative technique for the surgical management of rectal cancer, we performed transanal minimally invasive surgery assisted low anterior resection with total mesorectal excision (TAMIS-assisted LAR with TME) in a cadaver model. Transanal LAR via natural orifice transluminal endoscopic surgery has been reported in cadaveric series using rigid transanal platforms. This procedure has not been described using a combination of a single incision laparoscopy and TAMIS transanal endoscopic platform. We describe the first cadaveric series of TAMIS-assisted LAR with TME.
  
  
  METHODS
  TAMIS-assisted LAR with TME was successfully performed in five fresh human cadavers. The procedure was performed using the mini-Gelpoint single incision platform and the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA). The variables recorded were age, body mass index (BMI), operative time, complications, and specimen length. The grade of the TME was determined by evaluation of the specimen by photo documentation by a gastrointestinal pathologist.
  
  
  RESULTS
  All cadavers were male with a mean age of 71 ± 8 years and mean BMI of 28 ± 3 kg/m(2). The mean operative time was 200 ± 55 min (range 128-249 min). The quality of the TME was grade I (complete) with intact mesorectum in all five cases. The mean specimen length was 36.8 ± 3.4 cm.
  
  
  CONCLUSIONS
  TAMIS-assisted LAR with TME was feasible. A high-quality TME can be achieved using this innovative technique. Transanal endoscopic total mesorectal dissection may revolutionize the surgical management of rectal cancer. However, multicenter clinical trials are needed to further evaluate the oncologic safety and surgical outcomes of transanal endoscopic TME using various platforms before widespread application of this new technique.
authors.affiliation: Department of Surgery, University of California, San Diego, San Diego, CA, USA. emclemore@ucsd.edu
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: McLemore
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Coker
authors.forename: Bikash
authors.initials: B
authors.lastname: Devaraj
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Chakedis
authors.forename: Ali
authors.initials: A
authors.lastname: Maawy
authors.forename: Tazo
authors.initials: T
authors.lastname: Inui
authors.forename: Mark A
authors.initials: MA
authors.lastname: Talamini
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
authors.forename: Michael R
authors.initials: MR
authors.lastname: Peterson
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.forename: Sonia
authors.initials: S
authors.lastname: Ramamoorthy
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D001003:Anal Canal; D002102:Cadaver; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D012007:Rectum / Q000601:surgery*