Development of a Synthetic Simulator for Training in Transanal Minimally Invasive Surgery (TAMIS)

Transanal minimally invasive surgery (TAMIS) represents a significant advancement in the local excision of rectal neoplasms, yet its adoption is hindered by a demanding learning curve characterized by instrument crowding and restricted triangulation. Traditional training models, such as cadaveric or animal workshops, are often limited by high costs and ethical constraints. The present study describes the development and technical validation of a synthetic simulator for TAMIS training using an elastomeric pelvic mannequin. Unlike models requiring active CO2 insufflation, this simulator ensures self-sustaining lumen patency due to the material's resilience, effectively mimicking the middle and upper rectum in a benchtop setting. The experimental setup utilized a standard single-access port (GelPoint Path, Applied Medical) lubricated with lidocaine gel and a 10-mm 30-degree laparoscope to replicate clinical conditions. Technical assessment focused on intraluminal rectal wall suturing, demonstrating realistic tissue resistance and accurate reproduction of spatial constraints. This reproducible and portable model offers a viable alternative for democratizing advanced proctology education, allowing for exhaustive deliberate practice in a risk-free environment prior to clinical application.