Combined transanal excision (TAE) and transanal minimally invasive surgery (TAMIS) for a full thickness excision of a giant tubulovillous adenoma

Transanal minimally invasive surgery (TAMIS) is a rapidly developing minimally invasive method for high quality excision of rectal polyps and early rectal neoplasia. Treatment via TAMIS offers more advantages over other surgical modalities including endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), or a conventional transanal excision (TAE). We present a case of a successful excision of a giant 10 cm × 8 cm tubulovillous adenoma (TVA) with high grade dysplasia (HGD) located in the mid and low rectum using the TAMIS technique after an initial debulking. A 69-year-old male was found to have a large mid and low rectal polyp with raised components, located 1–1.5 cm from the dentate line, encompassing the lateral and posterior aspects of the rectum. Biopsy revealed a TVA with HGD. After colorectal evaluation and endoscopic rectal ultrasound (ERUS), no submucosal invasion was found, and the patient was offered a TAE via TAMIS. During the procedure, snare polypectomy was initially used to decrown the raised components of the polyp, so that the distal boundaries of the lesion could be identified and the TAMIS port inserted. Full thickness excision of the polyp with primary closure of the remaining rectal defect was successfully performed thereafter using a combined TAMIS and transanal technique. Follow up flexible sigmoidoscopy demonstrated no recurrence at the excision site.