TAMIS is transanal microsurgery. It's a new cutting-edge, minimally-invasive technique
for removing large, complex polyps in the rectum or even early cancers. It's what we
call natural orifice surgery. This means that we perform the surgery through a natural opening
on the body. In this case, the anal canal. By inserting a small port and effectively
doing keyhole surgery through it. TAMIS's organs sparing surgery. In that, it avoids the need
to remove larger sections of the bowel containing a polyp or an early cancer, and therefore
there's less impact on bowel function and in some cases, it can avoid the need for a
permanent stoma.
If you're thought to be a suitable candidate
for TAMIS, you'll be asked to come to hospital to have the procedure which is performed under
a general anaesthetic. This means that you'll be asleep for the operation and an anaesthetist
will give you the medication for the anaesthetic and there're specialised surgeons such as
myself who will perform the procedure for you. When we do the operation, we put a small
port into the anal canal and we attach a gas supply to inflate the rectum so that we have
a nice view of the lesion we need to remove. We then use some long laparoscopic instruments
including a cutting device, a retractor, and some scissors to remove the lesion in its
entirety. We then extract it through the port. We normally check again to make sure there's
no bleeding and put some local anaesthetic into the area to keep you more comfortable
afterwards. Most people only need to spend one night in hospital after this procedure
and find it to be really quite comfortable.
There are two main groups of people who'd
make a good candidate for TAMIS. Firstly, older people who have lots of medical problems who
would be very high risk for having a long general anaesthetic and a major operation
to remove their early cancer or even their polyp, and the second group is anyone else
who had an early rectal cancer or a large complex rectal polyp who didn't want to have
a larger operation or someone with the very low lesion, who wanted to avoid the necessity
of having a permanent stoma. If you've been diagnosed with a rectal cancer or polyps and
want to know if you're suitable for this procedure, your scans, your endoscopy and your biopsy
results will need to be assessed in a specialist MDT where we sit down with a surgeon, a radiologist
an endoscopist, an oncologist and often a pathologist to make an assessment of all the
information about your lesion and see whether you'll be suitable for this. Sometimes it's
necessary to repeat a scan or an endoscopy as we look for specific things to see if the
lesion could be removed by this technique. Not all rectal cancers or polyps are suitable
for this and this is based on a specialist assessment.
It's difficult to put hard figures on the success rate of the procedure because this
is relatively new, so there's not a lot of published literature about it. However, most
people feel that it is successful at moving large polyps and even early cancers without
an unacceptably high risk of recurrence or leaving residual disease behind. One of the
main advantages of it is that unlike removing lesions like this with a colonoscope which
removes the lesion in several pieces, the TAMIS technique removes the lesion on block,
in one piece, so that we can be sure if there is a cancer within it, it has been completely
removed. In addition to this, because this technique involves removing only a small portion
of the wall of the bowel as opposed to a long segment of the bowel with major surgery, it
has a lot less impact on bowel function: how your bowel works afterwards.
After the surgery you'll be asked to stay hospital overnight so we can properly monitor
you and make sure you're comfortable before you're discharged. After you've gone home,
the specimen we've removed will be sent to the pathologist to be examined under the microscope.
It usually takes about a week or so to get the results back from this. What happens next
depends on whether the specimen was a benign polyp or if there was a cancer within it.
Everybody will have a further endoscopic test to check the site where the lesion was removed
has completely healed three months further down the line from the operation. If your
polyp was completely benign, the only further surveillance you'll need is regular future
colonoscopies to make sure you haven't grown any more. If there was a cancer in the lesion
removed, you may require further treatment. This might be surgery or possibly chemotherapy
or radiotherapy. But the nice thing about TAMIS is, it doesn't preclude any of those
further treatments. You will then be put into a five-year cancer surveillance programme
that involves having CT scans, colonoscopies and tumour marker blood tests at regular intervals
to be sure that the cancer hasn't recurred.