TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series

Elisabeth C. McLemore, Alisa Coker, Bikash Devaraj, Jeffrey Chakedis, Ali Maawy, Tazo Inui, Mark A. Talamini, Santiago Horgan, Michael R. Peterson, Patricia Sylla, Sonia Ramamoorthy

Research output: Contribution to journalArticle

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/m2. 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.

Original languageEnglish (US)
Pages (from-to)3478-3484
Number of pages7
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number9
DOIs
StatePublished - Sep 2013
Externally publishedYes

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Cadaver
Rectal Neoplasms
Operative Time
Body Mass Index
Natural Orifice Endoscopic Surgery
Minimally Invasive Surgical Procedures
Documentation
Laparoscopy
Multicenter Studies
Dissection
Clinical Trials
Safety

Keywords

  • Colorectal cancer
  • Endoscopy
  • Gastrointestinal cancer
  • Surgical

ASJC Scopus subject areas

  • Surgery

Cite this

TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series. / McLemore, Elisabeth C.; Coker, Alisa; Devaraj, Bikash; Chakedis, Jeffrey; Maawy, Ali; Inui, Tazo; Talamini, Mark A.; Horgan, Santiago; Peterson, Michael R.; Sylla, Patricia; Ramamoorthy, Sonia.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 9, 09.2013, p. 3478-3484.

Research output: Contribution to journalArticle

McLemore, EC, Coker, A, Devaraj, B, Chakedis, J, Maawy, A, Inui, T, Talamini, MA, Horgan, S, Peterson, MR, Sylla, P & Ramamoorthy, S 2013, 'TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series', Surgical Endoscopy and Other Interventional Techniques, vol. 27, no. 9, pp. 3478-3484. https://doi.org/10.1007/s00464-013-2889-4
McLemore, Elisabeth C. ; Coker, Alisa ; Devaraj, Bikash ; Chakedis, Jeffrey ; Maawy, Ali ; Inui, Tazo ; Talamini, Mark A. ; Horgan, Santiago ; Peterson, Michael R. ; Sylla, Patricia ; Ramamoorthy, Sonia. / TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series. In: Surgical Endoscopy and Other Interventional Techniques. 2013 ; Vol. 27, No. 9. pp. 3478-3484.
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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/m2. 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.",
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AU - McLemore, Elisabeth C.

AU - Coker, Alisa

AU - Devaraj, Bikash

AU - Chakedis, Jeffrey

AU - Maawy, Ali

AU - Inui, Tazo

AU - Talamini, Mark A.

AU - Horgan, Santiago

AU - Peterson, Michael R.

AU - Sylla, Patricia

AU - Ramamoorthy, Sonia

PY - 2013/9

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N2 - 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/m2. 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.

AB - 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/m2. 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.

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KW - Gastrointestinal cancer

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