Transanal Endoscopic Microsurgical Excision

Transanal endoscopic microsurgical excision is a procedure to remove benign polyps or cancerous growths from the rectum without an incision.

Transanal endoscopic microsurgical excision (sometimes abbreviated TEM) is a minimally invasive surgical procedure. TEM allows a surgeon to remove polyps or early cancers without the need for large incisions or removing the rectum.

Learn more about transanal endoscopic microsurgical excision, including its definition, indications, candidate criteria, the surgical process, post-operative care, and potential risks and complications.

What is transanal endoscopic microsurgical excision?

TEM is a minimally invasive surgical technique designed to remove rectal polyps and early-stage rectal cancer. The procedure is performed through the anus using specialized endoscopic instruments, enabling precise excision of lesions with minimal disruption to surrounding tissues. TEM offers the advantage of reduced recovery time, less postoperative pain, and lower complication rates compared to traditional open or laparoscopic surgery.

Who might need transanal endoscopic microsurgical excision?

Transanal endoscopic microsurgical excision may be an option for people with benign rectal lesions or early-stage rectal cancer. Indications for TEM may include:

• Adenomas: Large or sessile polyps that are difficult to remove via traditional colonoscopy.
• Villous adenomas: High-risk polyps that require complete excision to prevent progression to cancer.
• Rectal polyps: Non-cancerous growths that need to be removed due to size, persistence, or symptoms.
• T1 and select T2 cancers: Early-stage rectal cancer that is confined to the superficial layers of the rectal wall, with no evidence of lymph node involvement or distant metastasis.
• Carcinoid tumors: Small neuroendocrine tumors that are localized and suitable for local excision.
• Non-invasive lesions: Lesions with clear margins and no invasion into deeper layers of the rectal wall.

Who is a candidate for transanal endoscopic microsurgical excision?

To determine if a person is a good candidate for this procedure, a health care provider may use certain tests, including:

• Lesion characteristics: Size, location, and histological features of the rectal lesion, determined through preoperative imaging and biopsy.
• Tumor staging: Assessment using modalities such as endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI) to determine the depth of invasion and absence of lymph node involvement.
• Overall health: Candidates should be in good general health and free from conditions that would contraindicate surgery.
• Absence of metastasis: No evidence of distant spread or involvement of lymph nodes outside the rectal area.
• Physical examination: Comprehensive examination to assess the patient’s overall health and suitability for surgery.
• Imaging studies: MRI, endoscopic ultrasound, or CT scans to examine the lesion and surrounding tissue.
• Colonoscopy: Preoperative colonoscopy to visualize the lesion and obtain biopsy samples.
• Histological assessment: Biopsy analysis to determine the nature of the lesion and ensure appropriate risk stratification.

What happens during a colonoscopy?>>

How does transanal endoscopic microsurgical excision work?

Transanal endoscopic microsurgical excision is typically performed under general anesthesia.

The surgeon uses an instrument called a proctoscope, which includes a camera. The proctoscope is placed through the anus, so the surgeon can see and remove the polyps or cancerous growths.

After the procedure, most patients have minimal pain and are back to normal activities within a few days.

Be sure to follow any instructions from your health care provider to prepare for the surgery and recover after surgery.

Transanal endoscopic microsurgical excision (TEM) is an effective and minimally invasive technique for the removal of rectal lesions, offering significant benefits in terms of recovery and outcomes. Understanding the indications, surgical process, and potential risks and complications is essential for making informed decisions. If you or a loved one may benefit from TEM, consulting with a specialized colorectal surgical team will help develop a personalized care plan tailored to your specific needs and circumstances.