Rectal Cancer
TAMIS Surgery
Transanal local excision through the anal canal — no abdominal incision
TAMIS surgery reaches selected rectal lesions through the anal canal without an abdominal incision — natural-orifice transanal surgery, not full NOTES. TEM is the dedicated platform in the same family. The aim is full-thickness local excision when the lesion fits — not for every rectal tumor.
Local excision is oncologic surgery with a narrow indication. Size, site, grade, MRI, and margins decide. TAMIS is not TaTME (transanal total mesorectal excision).
Natural-orifice access
Reach the rectum through a natural orifice — no abdominal incision
In TAMIS the working channel is the anal canal, not the abdominal wall. For a suitable rectal lesion, the surgeon can dissect and complete a full-thickness excision inside the rectum under high-definition vision.
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
The rectum is reached through the anal canal, not through the abdominal wall.
Three ways to think about access
1
Abdominal approach
Access through the abdominal wall
2
TAMIS
Natural orifice → anal canal → rectum
3
Single-port robotic TAMIS
Natural orifice + one transanal port + wristed robotic instruments
Who may be a candidate?
Typical candidates include superficial (T1) and selected T2 lesions, small polyps or early rectal tumors that look fully excisable, favorable grade, and MRI without locally advanced features. Height from the sphincter changes the plan.
- Early T stage (mostly T1, selected T2)
- Small lesion, favorable grade
- MRI without mesorectal or nodal concern
- Full-thickness excision feasible
TEM and TAMIS
Both work through the anal canal. An abdominal incision is not part of this access. TEM is a dedicated platform. TAMIS uses a transanal port and camera for the same local-excision principle. Both need a full-thickness specimen and a margin read.
Single-port robotic TAMIS
One transanal access point
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
The da Vinci Single Port (SP) system is one of the newer robotic platforms with technical features that fit transanal work especially well. This setup is also called da Vinci SP TAMIS. Through one transanal access point, a surgeon-controlled 3D camera and multi-jointed instruments can support dissection, suturing, and tissue handling in a narrow rectal lumen. A single cannula is designed to reduce the external-arm collisions that several robotic arms can create in a tight space. That is a design feature, not proof of fewer complications, faster recovery, or better cancer outcomes. How the platform is set up is on the da Vinci single-port page.
- One transanal access point
- Surgeon-controlled 3D vision
- Wristed instruments through the same port
- Dissection and suturing in a narrow lumen
TME and TaTME are different operations
Total mesorectal excision removes the mesorectum intact and remains standard for most mid and locally advanced rectal cancers. TaTME is that excision done from below. TAMIS is a platform for local excision of a selected lesion. They share a transanal family, not the same operation. Local excision does not clear lymph nodes. High grade, lymphovascular invasion, or a positive margin may mean salvage TME.
After local excision
Pathology may lead to surveillance, extra treatment, or TME. Follow-up uses endoscopy and MRI. Poor selection raises local recurrence risk, which is why the indication stays narrow.
Common questions
Does TAMIS need an abdominal incision?
No. Access is through the anal canal. Abdominal-wall ports are not part of the plan.
Is TAMIS the same as TaTME?
No. TAMIS is local excision of a selected lesion. TaTME is transanal total mesorectal excision.
Is single-port robotic TAMIS better for everyone?
Comparative evidence does not support that claim. Single-port offers technical features suited to a narrow transanal field. It is not a promise of better outcomes.
What if pathology is unfavorable?
High-risk features or a positive margin lead to a talk about salvage TME and/or further treatment. Pathology follow-up is essential.
Evidence
Scientific sources
Show sources · 3Guidelines for transanal local excision (TEM / TAMIS) in very early rectal disease. TAMIS is not TaTME.
Evidence
Scientific sources
- 1. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upESMO · 2017 (see the ESMO GI portal for updates) · DOI: 10.1093/annonc/mdx224Open source →
- 2. NCCN Clinical Practice Guidelines in Oncology: Rectal CancerNCCN · Current versionOpen source →
- 3. ASCRS clinical practice guidelines libraryAmerican Society of Colon & Rectal Surgeons (ASCRS) · Guideline libraryOpen source →
Last reviewed: 22 October 2026. Links go to publisher pages.
This content is for education only and is not medical advice. TNT, watch-and-wait, and surgery decisions are individualized using staging, MRI findings, and tumor-board review.