Transanal endoscopic microsurgery

Smith, Lee E.; Ko, Sung Tao; Saclarides, Theodore J.; Caushaj, Phillip; Orkin, Bruce A.; Khanduja, K. S.

doi:10.1007/bf02053811

Cited by 107 publications

(78 citation statements)

References 11 publications

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“…Other studies have also demonstrated good results with low recurrence and high survival for selected pT1N0 rectal adenocarcinomas treated by TEM alone 2,4,8,13,20,21,36 . In the advent that pathological examination reveals a pT1 lesion with unfavorable features or a more advanced lesion the authors recommend complementary treatment with radical surgery and/or CMT.…”

Section: Early Rectal Cancersmentioning

confidence: 89%

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

Nahas

Marques

et al. 2010

ABCD, arq. bras. cir. dig.

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HEADINGS -Colorectal surgery. Combined modality therapy. Carcinoid.ABSTRACT -Transanal endoscopic microsurgery (TEM) provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Based on review of the literature and in the authors experience, this review present the method and indications for TEM.RESUMO -A microcirurgia endoscópica transanal (TEM) é procedimento alternativo minimamente invasivo ao tratamento cirúrgico radical para excisão de tumores benignos e malignos do reto. Ela oferece possibilidade operatória aos procedimentos cirúrgicos convencionais (ressecção anterior baixa ou amputações abdominoperineais), as quais acarretam alta morbimortalidade. Baseada na revisão da literatura e na experiência própria dos autores, esta revisão tem por objetivo apresentar o método e as indicações para a TEM.

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Section: Early Rectal Cancersmentioning

confidence: 89%

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

Nahas

Marques

et al. 2010

ABCD, arq. bras. cir. dig.

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“…The latter include inadvertent entry into the peritoneal cavity during fullthickness excision of high rectal lesions located above the peritoneal reflection [17] . While this occurrence was originally considered a major complication of TEM and was managed by conversion to laparotomy in an effort to prevent intraabdominal infection [18] , a study comparing the morbidity associated with fullthickness excision with and without peritoneal entry in 34 TEM fullthickness excisions demonstrated that in all 11 cases where the peritoneal cavity was inad vertently entered and subsequently closed, no infectious complications were noted [19] . In addition, no significant differences in the complication rates were noted between the groups with or without peritoneal entry [19] .…”

Section: Advantages Of Transcolonic/ Transanal Notes Accessmentioning

confidence: 99%

NOTES in the management of colorectal diseases: Current experience and future directions

Sylla

2010

WJGS

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Clinical implementation and widespread application of natural orifice translumenal surgery (NOTES) has been limited by the lack of specialized endoscopic equipment, which has prevented the ability to perform complex procedures including colorectal resections. Relative to other types of translumenal access, transanal NOTES using transanal endoscopic microsurgery (TEM) provides a stable platform for endolumenal and direct translu menal access to the peritoneal cavity, and specifically to the colon and rectum. Completely NOTES transanal rectosigmoid resection using TEM, with or without transgastric endoscopic assistance, was demonstrated to be feasible and safe in a swine survival model. The same technique was successfully replicated in human cadavers using commercially available TEM, with end oscopic and laparoscopic instrumentation. This approach also permitted complete rectal mobilization with total mesorectal excision to be performed completely tra nsanally. As in the swine model, transgastric and/or transanal endoscopic assistance extended the length of proximal colon mobilized and overcame some of the difficulties with TEM dissection including limited end oscopic visualization and maladapted instrumentation. This extensive laboratory experience with NOTES tra nsanal rectosigmoid resection served as the basis for the first human NOTES transanal rectal cancer excision using TEM and laparoscopic assistance. Based on this early clinical experience, NOTES transanal approach using TEM holds significant promise as a safe and substantially less morbid alternative to conventional colorectal resection in the management of benign and malignant colorectal diseases. Careful patient selection and substantial impr ovement in NOTES instrumentation are critical to optimize this approach prior to widespread clinical application, and may ultimately permit completely NOTES transanal colorectal resection.

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“…Recurrence of rectal polyps has been reported to be 4-13 %, and redo-TEM remains an option in such recurrences. TEM is increasingly being used for the excision of lesions in patients who are poor surgical candidate [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience

et al. 2014

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Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that is increasingly being used to treat early rectal cancer (T1/T2). We studied the outcomes of TEM for rectal cancer at our institution looking at the indication, recurrence rate, need for further radical surgery, 30-day and 12-month mortality and complication rate. We performed a retrospective analysis of prospectively collected data of cases between 2008 and 2012: 110 TEM procedures were performed during this period: 40 were confirmed rectal cancers and 70 were benign. We analysed the data for the 40 patients with confirmed rectal cancer. Thirty (75 %) of the subjects were male with a mean age of 71±10 years (range 49-90 years) and 19 (48 %) patients were ASA 3 and 4. Nineteen (48 %) of cancers were pT1, eighteen (45 %) were pT2, two (5 %) were pT3 and one was yPT0. Mean specimen size was 66±20 mm (range 33-120 mm) with a mean polyp size of 41±24 mm (range 18-110 mm). The mean cancer size was 24±13 mm (range 2-50 mm). Average distance from the anal verge was 70 ±37 mm (range 10-150 mm), and the mean operating time was 72±22 min (range 40-120 min), with an average blood loss of 28±15 ml (range 10-50ml). Median hospital stay was 2±1 days (range 1-7 days). Complete excision (R0) was achieved in 37 (93 %) patients. Minor post-operative complications included urinary retention in two and pyrexia in three patients. There were no 30-day or 12-month mortalities. Mean follow-up was 13±11 months, range (3-40 months) Local recurrence occurred in two (5 %) patients, both underwent redo TEM. Twelve (30 %) patients underwent laparoscopic radical resections (seven AR and five APER) post-TEM. Post-operative histology confirmed pT0N0 in 7/12 patients. Three were lymph node-positive (T0N1), one was pT3N1 and the fifth was pT3N2. TEM is associated with quicker recovery, shorter hospital stay and fewer complications than radical surgery. It is a good alternative to radical surgery in early rectal cancer, especially for high-risk patients. Recurrent tumours can be treated with redo TEM.

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Transanal endoscopic microsurgery

Abstract: TEM has a low complication rate. By carefully selecting small, superficial cancers and adenomas, TEM results in superior outcome over other approaches to the mid and upper rectum.

Cited by 107 publications

References 11 publications

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

NOTES in the management of colorectal diseases: Current experience and future directions

Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience

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