Transanal endoscopic microsurgical excision

Abstract

Transanal endoscopic microsurgery (TEM) allows the minimally invasive local excision of rectal tumors located between 2-4 and 18 cm above the anal verge with the aid of a special operative rectoscope and a magnified view. This technique is not yet generally established because of the necessary special instrumentation and tools, unusual technical aspects of the approach, and stringent patient selection criteria (Fig. 15.1). Compared with conventional transanal resection, TEM provides superior exposure of tumors higher up in the rectum (i. e., up to 18 cm from the anal verge). The greater precision of resection, combined with low (relative to anterior resection) morbidity (5-10%) and short duration of hospitalization make this technique a reliable, and in some cases, more effective surgical approach than laparotomy or laparoscopy with low anterior resection, provided careful patient selection is performed. © 2010 Springer-Verlag Berlin Heidelberg.