Novel Surgical Technique Enables Scarless Removal of Large Polyps

A new operating platform for Trans-Anal Minimally Invasive Surgery (TAMIS) allows surgeons to excise large rectal polyps and tumor masses that cannot be completely removed during a routine colonoscopy.

During a TAMIS procedure, thin surgical instruments are placed through a soft but stable surgical platform--similar to a single incision laparoscopy (SIL) port--that rests inside the anus. The platform permits full visualization of the rectal growth, allowing surgeons to precisely access and excise the abnormality. The intact growth can then be removed through the anus, allowing pathologists to more accurately evaluate and diagnose its thickness. The tissue defect where the growth was removed is then closed with internal stitches; there are no permanent scars on the abdomen or around the anus.


TAMIS, which was pioneered at Florida Hospital (Winter Park, USA) by Sam Atallah, MD, will likely serve as the future platform for rectal natural orifice translumenal endoscopic surgery (NOTES), and may also have implications for treating patients with familial adenomatous polyposis, Gardner's syndrome, and Lynch syndrome, inherited genetic conditions that result in the mass growth of polyps.

“With the use of this new surgical platform, we can now offer patients an innovative, less invasive procedure to remove advanced polyps with significantly less pain and scarring compared to the standard surgical procedure,” said Elisabeth McLemore, MD, a colorectal surgeon at the University of California, San Diego (UCSD; USA), and the third surgeon in the world to perform the procedure. “Instead of a major abdominal operation with removal and reconstruction of the colon and rectum, we can remove the growth by operating through an existing natural body opening.”

“What we are seeing here is an evolution of natural orifice translumenal endoscopic surgery, the ability to perform complex operations through natural body openings,” added Professor Mark Talamini, MD, chairman of surgery and codirector of the Center for the Future of Surgery at the UCSD Health System. “Four years ago we predicted that NOTES would evolve to treat early forms of cancers, and that is what we are seeing now at UC San Diego.”

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