TAMIS management of large peritoneal entry for recurrent rectal polyp - A video vignette

Factors which influence decision making in choice of approach for rectal tumours include patient factors, oncologic factors and size and location of the tumour. In the setting of recurrent polyps, transanal excision is an appropriate modality of treatment. We present a video vignette of transanal minimally invasive surgery (TAMIS) for an anterior recurrent rectal poylp and management of a massive peritoneal entry. The polyp was 4cm in size and 8cm from the anal verge. With the patient in the prone jackknife position, we insert a GelPOINT™ Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, CA, USA) in combination with the AirSeal™ insufflation system (Conmed, Niagara. Falls, ON, Canada) to maintain pneumorectum. Breach into the peritoneal cavity was repaired with continuous V-Loc suture and checked transabdominally with an air leak test performed laparoscopically. The patient was discharged home well post operative day 1. Final histology revealed tubulovillous adenoma with low grade dysplasia and 5 benign reactive lymph nodes in the adjacent fat. TAMIS is a cost effective and safe treatment modality for patients with large recurrent rectal polyps. We demonstrate in this video the effective management of a large peritoneal entry using TAMIS.