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.