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Minimally invasive options are expanding for people with rectal cancer, large benign polyps and pelvic floor disorders, but timing matters. Lesions that grow or advance can close the door on less invasive approaches, and symptoms like fecal incontinence often go unmentioned for years.

In an interview with CURE, Dr. Mark Zhao, a colorectal surgeon at UCSF Health, discussed these techniques. Transanal minimally invasive surgery, or TAMIS, is gaining attention for patients. It is an excellent option for selected patients, most often those with large benign rectal polyps or early rectal cancers that do not require a more radical resection. Early referral is important, because patients may lose the opportunity for these local excision options as lesions become larger or more advanced.

Whenever it is oncologically appropriate, the TAMIS procedure allows physicians to preserve rectal and anorectal function while avoiding abdominal incisions or the consequences of abdominal surgery. The result is often less pain and faster recovery. In many TAMIS cases, patients can be discharged the same day, making the experience more convenient.

Technology expands surgical options

For transabdominal procedures, the group uses the da Vinci single‑port surgical robot. This platform allows surgery through just a single incision or access site. It contrasts with conventional minimally invasive surgery, which typically requires multiple small incisions around the abdomen. The UCSF team was involved in the early development and evaluation of this single‑port robot.

The robot uses a single incision roughly two to four centimeters in size. The previous multiport system required several ports, each about eight millimeters to 1.2 centimeters. This approach helps minimize soft‑tissue trauma. At UCSF, the procedure is commonly used for appropriately selected patients with rectal prolapse. The treatment of choice for that condition is a robotic ventral mesh rectopexy performed through a small Pfannenstiel incision.

Patients have described less discomfort after the single‑incision ventral mesh rectopexy. Outcomes appear similar to those of the multiport method. Currently, the surgeons do not use the robotic platform for transanal procedures involving pelvic floor disorders, though that may change in the future.

For carefully selected patients, the single‑port platform allows surgeons to operate through just one incision while maintaining the same oncologic principles as conventional minimally invasive surgery. The priority in cancer surgery is always removing the tumor—oncologic outcomes matter most. When that can be done with minimal trauma, recovery speeds up.

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Managing pelvic floor disorders

This field presents significant challenges for both patients and doctors. Many patients are reluctant to discuss symptoms, especially fecal incontinence, due to embarrassment or a belief that nothing can be done. Patients often describe symptoms vaguely, using terms like accidents or leakage. A simple screening question such as “How is your bowel function?” often uncovers these issues. Early recognition matters because effective treatments exist.

The initial evaluation typically involves a medication review, bowel diary, stool consistency review, and obstetric and surgical history. Doctors also encourage starting conservative management with fiber supplementation. Fiber should be mixed with water, as supplemental fiber benefits almost everyone. However, clinicians should not delay referral, as symptoms can greatly affect quality of life.

As the patient population ages, pelvic floor disorders become more common. These issues were initially underdiagnosed and undertreated, but recognition has improved over time. Fecal incontinence, rectal prolapse and obstructive defecation disproportionately affect women, particularly those who have been pregnant or given birth.

Patients dealing with overlapping symptoms, such as pelvic organ prolapse alongside rectal prolapse, require coordinated care. This population is best managed with multiple disciplines. Both conditions often require collaboration between colorectal surgery and urogynecology. When a patient has pelvic organ prolapse with rectal prolapse, outcomes improve when both issues are addressed simultaneously.

Often patients also have urinary incontinence or urinary issues. Treatment for both may stem from a similar procedure, such as the sacral nerve stimulator. Coordination with urogynecology is helpful in these cases. Pelvic floor physical therapy is also a vital part of multidisciplinary care. Specialists at UCSF offer physiology testing, such as manometry and endoanal ultrasound, and guided biofeedback.

While the technology offers clear physical benefits, the reliance on early detection highlights a systemic challenge where patients delay seeking care. The disparity between primary care and colorectal surgery regarding fecal incontinence often leads to years of suffering before effective intervention. By the time patients reach a specialist, the window for simple, less invasive procedures may have closed.

Recovery is often swift.