Transanal Minimally Invasive Surgery (TAMIS) in Qatar: initial experience.

BACKGROUND: Transanal Minimally Invasive Surgery (TAMIS) has revolutionized local excision of mid and high rectal lesions; benign or malignant. It is a technique that is developed as a hybrid between Transanal Endoscopic Microsurgery (TEM) and laparoscopic surgery for resection of rectal lesions. METHODS: We retrospectively reviewed prospectively collected data on patients who underwent TAMIS for benign and early malignant rectal lesions between Jan 2015 and Sept 2019, at Hamad General Hospital, Doha, Qatar. We assessed the following outcomes: feasibility, fragmentation of specimen, operative time, length of stay (LOS) post-operative complications, and margin negativity. RESULTS: Seventeen consecutive patients underwent TAMIS for benign and malignant rectal lesions. The average length of stay (LOS) is 1.5 days (1-6 days). Seven patients had different types of benign adenomas, five patients had proven adenocarcinoma, three patients had well-differentiated neuroendocrine tumors, one patient with hyperplastic polyp, and one patient had inflammatory polyp. No fragmentation occurred or detected by histopathologic examination, except in a patient who had inflammatory polyp, where the lesion removed in two fragments. CONCLUSION: TAMIS procedure is feasible and safe even in a relatively low-volume colorectal unit. Using this tool, many patients can avoid unnecessary radical surgery. Therefore, we believe that TAMIS should form part of every specialized colorectal service repertoire. To our knowledge, this is the largest series in the gulf region.

Role of laparoscopic peritoneal biopsy in the diagnosis of peritoneal tuberculosis. A seven-year experience.

The diagnosis of asymptomatic abdominal tuberculosis,without characteristic laboratory and radiologic findings, is difficult. We therefore investigated the role of diagnostic laparoscopy in patients with suspected peritoneal tuberculosis(PTB). Patients admitted to Hamad General Hospital, Qatar,who underwent laparoscopic peritoneal biopsy for suspected PTB from January 2004 to December 2010 were retrospectively analysed. Factors assessed included patient age, sex, symptoms,clinical signs, CT scan findings, laparoscopic findings andhistopathological diagnosis. A total of 41 patients, 33 males(80.5%) and 8 females (19.5%), of mean age 31 years, underwent laparoscopic peritoneal biopsy for suspected PTB duringthe study period. Abdominal pain was the most common presenting symptom, observed in 33 (80.5%) patients.Computerized tomography (CT) of the abdomen showed as citesin 37 patients (90%), bowel nodules in 22 (54%), peritoneal thickening and nodules in 37 (90%) and enlarged mesenteric lymph nodes in 11 (27%). The classical gross laparoscopic appearance of peritoneal tuberculosis was observed in 38 patients (93%), whereas laparoscopic findings were normal in 3 patients (7%). Histopathological results confirmed granulomatous inflammation in 38 patients (93%). The sensitivity and specificity of gross laparoscopic appearance in diagnosing peritoneal TB were both 100%. Two patients experienced complications from laparoscopy (5%), but there were nolaparoscopy-related deaths. Laparoscopic peritoneal biopsy isa rapid and safe method of accurately diagnosing PTB.