**3. TAMIS instrumentation and technique**

With the increase in laparoscopic experience, some limitations of TEM, such as costs, need for specific technical training, dedicated equipment, and instrumentation, encouraged the development of the transanal minimally invasive surgery (TAMIS) platform in 2009 [11]. TAMIS needs only a single-incision laparoscopic surgery port (SILSTM Port, Covidien, Mansfield, MA) that is first lubricated and then introduced into the anal canal (**Figure 6**). Through the SILS port, a standard

**Figure 6.** *SILS™ port and modified laparoscopic instrument for TAMIS ©Medtronic.*

*Local Excision for the Management of Early Rectal Cancer DOI: http://dx.doi.org/10.5772/intechopen.105573*

bidimensional laparoscope and instrumentation are inserted into the rectum, and pneumorectum is achieved with a conventional laparoscopic insufflator. Therefore, TAMIS provides similar, although not equivalent, visibility as TEM without the need for expensive and specialized equipment.

Furthermore, TAMIS enables dissection from different angles in multiple quadrants, avoiding the changes in patient's position that may sometimes be required during TEM: all resections in TAMIS can be done in the lithotomy position. Initially TAMIS was employed only for local excision of distal rectal lesions, but it is reported to be a feasible option also for higher lesions with satisfactory outcome [12]. So, nowadays TAMIS is considered to be a valuable alternative to TEM, with technical advantages and same prognosis for full-thickness local excision of rectal lesions [13, 14].
