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Transanal minimally invasive surgical anal canal polyp resection

G Dapri, MD, PhD, FACS, FASMBS, Hon FPALES, Hon SPCMIN, Hon BSS, Hon CBCD, Hon CBC
Epublication WebSurg.com, Sep 2017;17(09). URL: http://websurg.com/doi/vd01en4958

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  • 2021
  • 103
  • 2017-09-11
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Background: Endoscopic submucosal dissection (ESD) has been known for a long time. Recently, transanal minimally invasive surgery (TAMIS) started to be popularized and it can be used in front of difficult cases for ESD.
Video: A 36-year-old woman underwent a TAMIS resection, after unsuccessful ESD, for a 2cm polyp located anteriorly in the anal canal, just beside the pectineal line. Preoperative work-up showed a uT1m versus T1sm N0 M0 lesion. The patient was placed in a prone position with a split leg kneeling position. The procedure was performed with a new reusable transanal platform, a monocurved coagulating hook, and a grasping forceps. The mucosal flap was closed using two absorbable running sutures, a monocurved needle holder, and a grasping forceps.
Results: Operative time was 90 minutes, and perioperative bleeding was 20cc. No perioperative complications were noted, and the patient was discharged on postoperative day 1. Pathological findings showed a 2 by 1.3 by 0.5cm villotubular adenoma with high-grade dysplasia and free margins.
Conclusions: TAMIS anal canal polyp resection allows for a meticulous dissection under a magnified exposure of the operative field, with a final mucosal flap closure in adequate ergonomic conditions.