927
DISEASES OF THE COLON & RECTUM VOLUME 57: 8 (2014)
BACKGROUND: Currently, the preferred method for local
excision of rectal polyps is transanal endoscopic microsurgery,
avoiding rectal resection. Transanal minimally invasive
surgery is a relatively new technique using a disposable
port in combination with conventional laparoscopic
instruments. This method is less expensive as compared
with transanal endoscopic microsurgery, relatively easy to
learn, and available. Despite wide adoption of transanal
minimally invasive surgery, to date only a few series on the
implementation and use of this technique are reported, and
detailed information on the effect of transanal minimally
invasive surgery on fecal continence is not available.
OBJECTIVE: The purpose of this work was to
prospectively assess the functional outcome after
transanal minimally invasive surgery using the Fecal
Incontinence Severity Index preoperatively and
postoperatively.
DESIGN: This was a prospective cohort study.
SETTINGS: The study was conducted at a large teaching
hospital.
PATIENTS: Patients included those who underwent
transanal minimally invasive surgery between October
2011 and September 2013.
INTERVENTIONS: Transanal minimally invasive surgery
was studied.
MAIN OUTCOME MEASURES: We measured postoperative
surgical and functional results.
RESULTS: A total of 37 patients underwent transanal
minimally invasive surgery during our study period. Short-
term morbidity rate was 14%, and positive resection margins
were reported in 6 cases (16%); in 1 of these patients, a local
recurrence was observed. Overall, there was a significant
decline in preoperative and postoperative Fecal Incontinence
Severity Index scores (p = 0.02), indicating an improvement
in anorectal function after transanal minimally invasive
surgery for patients with impaired preoperative continence.
Seventeen patients (49%) had impaired continence
before transanal minimally invasive surgery (mean Fecal
Incontinence Severity Index score = 21). Continence
improved in 15 (88%) of these patients after surgery; no
change was observed in 1 patient (6%), and continence
further decreased in another. In addition, 18 patients (51%)
had normal preoperative continence (Fecal Incontinence
Severity Index score = 0), of which 83% had no change in
functionality, and continence decreased in 3.
LIMITATIONS: No quality of life was measured.
CONCLUSIONS: Short-term functional results of
transanal minimally invasive surgery for rectal polyps are
excellent and comparable to functional results using the
dedicated transanal endoscopic microsurgery equipment.
More research on outcome after transanal minimally
invasive surgery is needed to assess morbidity rates and
oncologic clearance.
KEY WORDS: Fecal incontinence; FISI score; Functional
result; Rectal adenoma; SILS; SPTS; SSL; TAMIS; TEM;
TEMS; Transanal minimally invasive surgery.
C
urrently, the preferred method for local resection
of rectal polyps is transanal endoscopic microsur-
gery (TEM). With this technique, a full-thickness
local excision of T1 rectal cancers, large polyps, and neu-
roendocrine tumors can be safely performed, and radi-
Transanal Minimally Invasive Surgery: Initial
Experience and Short-term Functional Results
Anandi H. W. Schiphorst, M.D.
1,2
s"ARBARA3,ANGENHOFF-$0H$
1
*OHN-ARING-$0H$&%"3#OLOPROCTOLOGY
1
!POLLO0RONK-$0H$&%"3#OLOPROCTOLOGY
2
$AVID$%:IMMERMAN-$0H$&%"3#OLOPROCTOLOGY
1
1 Department of Surgery, TweeSteden and St Elisabeth Hospital, Tilburg, the Netherlands
2 Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
Dis Colon Rectum 2014; 57: 927–932
DOI: 10.1097/DCR.0000000000000170
© The ASCRS 2014
Financial Disclosure: None reported.
Correspondence:$AVID$%:IMMERMAN-$0H$&%"3#OLO-
proctology), Department of Surgery, TweeSteden and St Elisabeth Hos-
pital, 5042 AD Tilburg, the Netherlands. E-mail: dzimmerman@tsz.nl
ORIGINAL CONTRIBUTION