TAMIS procedure for a recurrent rectal lesion at anastomotic site—A video vignette

TAMIS approach has emerged as one of the important tools in the management of rectal lesions. Since its inception in 2010, it has been increasingly adopted to treat both benign and malignant rectal lesions 1. The clarity of an angled scope, access to mid and upper rectum, short learning curve, less cost and similar set-up of laparoscopy have paved the way for its widespread adoption in colorectal service 2. Recently, it has emerged as one of the treatment options for organ preservation strategies in rectal cancer. With careful patient selection underpinned by good pre-operative imaging, it results in similar oncological outcomes with better functional outcomes and quality of life when compared to radical rectal resections 3. We present a case of an anastomotic recurrence in an elderly frail patient with a history of laparoscopic anterior resection for tubulo-villous adenoma. Given his age, comorbidities and prior pelvic surgery (and associated risks of ureteric/pelvic nerve injury and permanent stoma), he was considered high risk for radical resection. The multidisciplinary team (MDT) recommended a trans-anal minimally invasive surgery (TAMIS) procedure with formal radical resection reserved only if final pathology revealed malignancy. In literature, the use of TAMIS for recurrent rectal lesion at the anastomotic site is scarce. This case presents a challenge as the dissection planes are fibrosed (due to previous anastomosis) and while aiming for perirectal fat, there is a risk of rectal perforation. This video (Video 1) illustrates a step-by-step approach to excise such a lesion. Ejaz Ahmed Latif: Conceptualization; writing – original draft; writing – review and editing; data curation; visualization. Ali Toffaha: Writing – review and editing; resources; writing – original draft. Ammar Aleter: Writing – review and editing; writing – original draft. Amjad Parvaiz: Writing – review and editing; writing – original draft. Mohamed Abu Nada: Writing – review and editing; writing – original draft. Mohamed Kurer: Supervision; methodology; conceptualization; writing – original draft; writing – review and editing. The authors declare no conflict of interest and without any funding. The authors disclose no conflicts of interest related to the publication of this article. The authors conducted this study in accordance with the ethical principles described in the Declaration of Helsinki. IRB and institutional approval were taken from HMC medical research centre (MRC: 04-26-064). Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available on request. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.