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Clin Colon Rectal Surg 2015; 28(03): 165-175
DOI: 10.1055/s-0035-1562889
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transanal Endoscopic Microsurgery

Theodore John Saclarides
1   Loyola University Medical Center, Maywood, California
› Author Affiliations
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Publication History

Publication Date:
05 October 2015 (online)

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Abstract

Transanal endoscopic microsurgery (TEM) was developed by Professor Gerhard Buess 30 years ago at the dawn of minimally invasive surgery. TEM utilizes a closed proctoscopic system whereby endoluminal surgery is accomplished with high-definition magnification, constant CO2 insufflation, and long-shafted instruments. The end result is a more precise excision and closure compared to conventional instrumentation. Virtually any benign lesion can be addressed with this technology; however, proper patient selection is paramount when using it for cancer.

Keywords

transanal - endoscopic - endoluminal - rectal cancer
 

  • References

  • 1 Buess G, Theiss R, Hutterer F , et al. Transanal endoscopic surgery of the rectum - testing a new method in animal experiments [in German]. Leber Magen Darm 1983; 13 (2) 73-77
    PubMedGoogle Scholar
  • 2 Kipfmüller K, Buess G, Naruhn M, Junginger T. Training program for transanal endoscopic microsurgery. Surg Endosc 1988; 2 (1) 24-27
    CrossrefPubMedGoogle Scholar
  • 3 Buess G, Kipfmüller K, Ibald R , et al. Clinical results of transanal endoscopic microsurgery. Surg Endosc 1988; 2 (4) 245-250
    CrossrefPubMedGoogle Scholar
  • 4 Saclarides TJ, Bhattacharyya AK, Britton-Kuzel C, Szeluga D, Economou SG. Predicting lymph node metastases in rectal cancer. Dis Colon Rectum 1994; 37 (1) 52-57
    CrossrefPubMedGoogle Scholar
  • 5 Vavra P, Dostalik J, Vavrova M , et al. Transanal endoscopic microsurgery: a novel technique for the repair of benign rectovaginal fistula. Surgeon 2009; 7 (2) 126-127
    CrossrefPubMedGoogle Scholar
  • 6 Quinlan M, Cahill R, Keane F, Grainger R, Butler M. Transanal endoscopic microsurgical repair of iatrogenic recto-urethral fistula. Surgeon 2005; 3 (6) 416-417
    CrossrefPubMedGoogle Scholar
  • 7 Andrews EJ, Royce P, Farmer KC. Transanal endoscopic microsurgery repair of rectourethral fistula after high-intensity focused ultrasound ablation of prostate cancer. Colorectal Dis 2011; 13 (3) 342-343
    CrossrefPubMedGoogle Scholar
  • 8 Bochove-Overgaauw DM, Beerlage HP, Bosscha K, Gelderman WA. Transanal endoscopic microsurgery for correction of rectourethral fistulae. J Endourol 2006; 20 (12) 1087-1090
    CrossrefPubMedGoogle Scholar
  • 9 Kanehira E, Tanida T, Kamei A, Nakagi M, Iwasaki M, Shimizu H. Transanal endoscopic microsurgery for surgical repair of rectovesical fistula following radical prostatectomy. Surg Endosc 2015; 29 (4) 851-855
    CrossrefPubMedGoogle Scholar
  • 10 Baatrup G, Svensen R, Ellensen VS. Benign rectal strictures managed with transanal resection—a novel application for transanal endoscopic microsurgery. Colorectal Dis 2010; 12 (2) 144-146
    CrossrefPubMedGoogle Scholar
  • 11 Kato K, Saito T, Matsuda M, Imai M, Kasai S, Mito M. Successful treatment of a rectal anastomotic stenosis by transanal endoscopic microsurgery (TEM) using the contact Nd:YAG laser. Surg Endosc 1997; 11 (5) 485-487
    CrossrefPubMedGoogle Scholar
  • 12 Beunis A, Pauli S, Van Cleemput M. Anastomotic leakage of a colorectal anastomosis treated by transanal endoscopic microsurgery. Acta Chir Belg 2008; 108 (4) 474-476
    PubMedGoogle Scholar
  • 13 Zoller S, Joos A, Dinter D , et al. Retrorectal tumors: excision by transanal endoscopic microsurgery. Rev Esp Enferm Dig 2007; 99 (9) 547-550
    PubMedGoogle Scholar
  • 14 Serra Aracil X, Gómez Díaz C, Bombardó Junca J , et al. Surgical excision of retrorectal tumour using transanal endoscopic microsurgery. Colorectal Dis 2010; 12 (6) 594-595
    PubMedGoogle Scholar
  • 15 Buchs NC, Pugin F, Volonte F, Hagen ME, Morel P, Ris F. Robotic transanal endoscopic microsurgery: technical details for the lateral approach. Dis Colon Rectum 2013; 56 (10) 1194-1198
    CrossrefPubMedGoogle Scholar
  • 16 Liyanage C, Ramwell A, Harris GJ, Levy BF, Simson JN. Transanal endoscopic microsurgery: a new technique for completion proctectomy. Colorectal Dis 2013; 15 (9) e542-e547
    PubMedGoogle Scholar
  • 17 Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 2004; 232 (3) 773-783
    CrossrefPubMedGoogle Scholar
  • 18 Huh JW, Park YA, Jung EJ, Lee KY, Sohn SK. Accuracy of endorectal ultrasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation. J Am Coll Surg 2008; 207 (1) 7-12
    CrossrefPubMedGoogle Scholar
  • 19 Saclarides TJ. TEM/local excision: indications, techniques, outcomes, and the future. J Surg Oncol 2007; 96 (8) 644-650
    CrossrefPubMedGoogle Scholar
  • 20 Druzijanić N, Perko Z, Kraljević D , et al. Harmonic scalpel in transanal microsurgery. Hepatogastroenterology 2008; 55 (82-83) 356-358
    PubMedGoogle Scholar
  • 21 Ayodeji ID, Hop WC, Tetteroo GW, Bonjer HJ, de Graaf EJ. Ultracision Harmonic Scalpel and multifunctional tem400 instrument complement in transanal endoscopic microsurgery: a prospective study. Surg Endosc 2004; 18 (12) 1730-1737
    CrossrefPubMedGoogle Scholar
  • 22 Hermsen PE, Ayodeji ID, Hop WH, Tetteroo GW, de Graaf EJ. Harmonic long shears further reduce operation time in transanal endoscopic microsurgery. Surg Endosc 2009; 23 (9) 2124-2130
    CrossrefPubMedGoogle Scholar
  • 23 Ramirez JM, Aguilella V, Arribas D, Martinez M. Transanal full-thickness excision of rectal tumours: should the defect be sutured? a randomized controlled trial. Colorectal Dis 2002; 4 (1) 51-55
    CrossrefPubMedGoogle Scholar
  • 24 Buess G, Mentges B, Manncke K, Starlinger M, Becker HD. Technique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 1992; 163 (1) 63-69 , discussion 69–70
    CrossrefPubMedGoogle Scholar
  • 25 Simkens GA, Nienhuijs SW, Luyer MD, de Hingh IH. Massive surgical emphysema following transanal endoscopic microsurgery. World J Gastrointest Surg 2014; 6 (8) 160-163
    CrossrefPubMedGoogle Scholar
  • 26 Ganai S, Kanumuri P, Rao RS, Alexander AI. Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers. Ann Surg Oncol 2006; 13 (4) 547-556
    CrossrefPubMedGoogle Scholar
  • 27 Bignell MB, Ramwell A, Evans JR, Dastur N, Simson JN. Complications of transanal endoscopic microsurgery (TEMS): a prospective audit. Colorectal Dis 2010; 12 (7 Online): e99-e103
    PubMedGoogle Scholar
  • 28 Lee W, Lee D, Choi S, Chun H. Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 2003; 17 (8) 1283-1287
    CrossrefPubMedGoogle Scholar
  • 29 Flexer SM, Durham-Hall AC, Steward MA, Robinson JM. TEMS: results of a specialist centre. Surg Endosc 2014; 28 (6) 1874-1878
    CrossrefPubMedGoogle Scholar
  • 30 Marks JH, Valsdottir EB, DeNittis A , et al. Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy. Surg Endosc 2009; 23 (5) 1081-1087
    CrossrefPubMedGoogle Scholar
  • 31 Paganini AM, Balla A, Quaresima S, D'Ambrosio G, Bruzzone P, Lezoche E. Tricks to decrease the suture line dehiscence rate during endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM). Surg Endosc 2015; 29 (5) 1045-1050
    CrossrefPubMedGoogle Scholar
  • 32 Gavagan JA, Whiteford MH, Swanstrom LL. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg 2004; 187 (5) 630-634
    CrossrefPubMedGoogle Scholar
  • 33 Baatrup G, Borschitz T, Cunningham C, Qvist N. Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise. Surg Endosc 2009; 23 (12) 2680-2683
    CrossrefPubMedGoogle Scholar
  • 34 Koebrugge B, Bosscha K, Ernst MF. Transanal endoscopic microsurgery for local excision of rectal lesions: is there a learning curve?. Dig Surg 2009; 26 (5) 372-377
    CrossrefPubMedGoogle Scholar
  • 35 Gracia Solanas JA, Ramírez Rodríguez JM, Aguilella Diago V, Elía Guedea M, Martínez Díez M. A prospective study about functional and anatomic consequences of transanal endoscopic microsurgery. Rev Esp Enferm Dig 2006; 98 (4) 234-240
    PubMedGoogle Scholar
  • 36 Doornebosch PG, Gosselink MP, Neijenhuis PA, Schouten WR, Tollenaar RA, de Graaf EJ. Impact of transanal endoscopic microsurgery on functional outcome and quality of life. Int J Colorectal Dis 2008; 23 (7) 709-713
    CrossrefPubMedGoogle Scholar
  • 37 Herman RM, Richter P, Walega P, Popiela T. Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Colorectal Dis 2001; 16 (6) 370-376
    CrossrefPubMedGoogle Scholar
  • 38 Wang HS, Lin JK, Yang SH, Jiang JK, Chen WS, Lin TC. Prospective study of the functional results of transanal endoscopic microsurgery. Hepatogastroenterology 2003; 50 (53) 1376-1380
    PubMedGoogle Scholar
  • 39 Jin Z, Yin L, Xue L, Lin M, Zheng Q. Anorectal functional results after transanal endoscopic microsurgery in benign and early malignant tumors. World J Surg 2010; 34 (5) 1128-1132
    CrossrefPubMedGoogle Scholar
  • 40 Cataldo PA, O'Brien S, Osler T. Transanal endoscopic microsurgery: a prospective evaluation of functional results. Dis Colon Rectum 2005; 48 (7) 1366-1371
    CrossrefPubMedGoogle Scholar
  • 41 Jeon JH, Cheung DY, Lee SJ , et al. Endoscopic resection yields reliable outcomes for small rectal neuroendocrine tumors. Dig Endosc 2014; 26 (4) 556-563
    CrossrefPubMedGoogle Scholar
  • 42 Kawaguti FS, Nahas CS, Marques CF , et al. Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer. Surg Endosc 2014; 28 (4) 1173-1179
    CrossrefPubMedGoogle Scholar
  • 43 Arezzo A, Passera R, Saito Y , et al. Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large non-invasive rectal lesions. Surg Endosc 2014; 28: 427-438
    CrossrefPubMedGoogle Scholar
  • 44 Barendse RM, Oors JM, de Graaf EJ , et al. The effect of endoscopic mucosal resection and transanal endoscopic microsurgery on anorectal function. Colorectal Dis 2013; 15 (9) e534-e541
    PubMedGoogle Scholar
  • 45 Moore JS, Cataldo PA, Osler T, Hyman NH. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 2008; 51 (7) 1026-1030 , discussion 1030–1031
    CrossrefPubMedGoogle Scholar
  • 46 Lin GL, Meng WC, Lau PY, Qiu HZ, Yip AW. Local resection for early rectal tumours: Comparative study of transanal endoscopic microsurgery (TEM) versus posterior trans-sphincteric approach (Mason's operation). Asian J Surg 2006; 29 (4) 227-232
    CrossrefPubMedGoogle Scholar
  • 47 de Graaf EJ, Burger JW, van Ijsseldijk AL, Tetteroo GW, Dawson I, Hop WC. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis 2011; 13 (7) 762-767
    CrossrefPubMedGoogle Scholar
  • 48 Christoforidis D, Cho HM, Dixon MR, Mellgren AF, Madoff RD, Finne CO. Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 2009; 249 (5) 776-782
    CrossrefPubMedGoogle Scholar
  • 49 Borschitz T, Heintz A, Junginger T. The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation. Dis Colon Rectum 2006; 49 (10) 1492-1506 , discussion 1500–1505
    CrossrefPubMedGoogle Scholar
  • 50 Hompes R, McDonald R, Buskens C , et al; Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery Collaboration. Completion surgery following transanal endoscopic microsurgery: assessment of quality and short- and long-term outcome. Colorectal Dis 2013; 15 (10) e576-e581
    CrossrefPubMedGoogle Scholar
  • 51 Bach SP, Hill J, Monson JR , et al; Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery (TEM) Collaboration. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 2009; 96 (3) 280-290
    CrossrefPubMedGoogle Scholar
  • 52 Borschitz T, Heintz A, Junginger T. Transanal endoscopic microsurgical excision of pT2 rectal cancer: results and possible indications. Dis Colon Rectum 2007; 50 (3) 292-301
    CrossrefPubMedGoogle Scholar
  • 53 Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence?. Dis Colon Rectum 2001; 44 (9) 1345-1361
    CrossrefPubMedGoogle Scholar
  • 54 Doornebosch PG, Ferenschild FT, de Wilt JH, Dawson I, Tetteroo GW, de Graaf EJ. Treatment of recurrence after transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Dis Colon Rectum 2010; 53 (9) 1234-1239
    CrossrefPubMedGoogle Scholar
  • 55 Paty PB, Nash GM, Baron P , et al. Long-term results of local excision for rectal cancer. Ann Surg 2002; 236 (4) 522-529 , discussion 529–530
    CrossrefPubMedGoogle Scholar
  • 56 Ramirez JM, Aguilella V, Valencia J , et al. Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results. Int J Colorectal Dis 2011; 26 (4) 437-443
    CrossrefPubMedGoogle Scholar
  • 57 Duek SD, Issa N, Hershko DD, Krausz MM. Outcome of transanal endoscopic microsurgery and adjuvant radiotherapy in patients with T2 rectal cancer. Dis Colon Rectum 2008; 51 (4) 379-384 , discussion 384
    CrossrefPubMedGoogle Scholar
  • 58 Lezoche E, Guerrieri M, Paganini AM, Feliciotti F. Long-term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision. World J Surg 2002; 26 (9) 1170-1174
    CrossrefPubMedGoogle Scholar
  • 59 Lezoche E, Guerrieri M, Paganini AM, Baldarelli M, De Sanctis A, Lezoche G. Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 2005; 92 (12) 1546-1552
    CrossrefPubMedGoogle Scholar
  • 60 Guerrieri M, Feliciotti F, Baldarelli M , et al. Sphincter-saving surgery in patients with rectal cancer treated by radiotherapy and transanal endoscopic microsurgery: 10 years' experience. Dig Liver Dis 2003; 35 (12) 876-880
    CrossrefPubMedGoogle Scholar
  • 61 Tulchinsky H, Rabau M, Shacham-Shemueli E , et al. Can rectal cancers with pathologic T0 after neoadjuvant chemoradiation (ypT0) be treated by transanal excision alone?. Ann Surg Oncol 2006; 13 (3) 347-352
    CrossrefPubMedGoogle Scholar
  • 62 Kim CJ, Yeatman TJ, Coppola D , et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 2001; 234 (3) 352-358 , discussion 358–359
    CrossrefPubMedGoogle Scholar
  • 63 Mohiuddin M, Marks G, Bannon J. High-dose preoperative radiation and full thickness local excision: a new option for selected T3 distal rectal cancers. Int J Radiat Oncol Biol Phys 1994; 30 (4) 845-849
    CrossrefPubMedGoogle Scholar
  • 64 Schell SR, Zlotecki RA, Mendenhall WM, Marsh RW, Vauthey JN, Copeland III EM. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy. J Am Coll Surg 2002; 194 (5) 584-590 , discussion 590–591
    CrossrefPubMedGoogle Scholar
  • 65 Bonnen M, Crane C, Vauthey JN , et al. Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biol Phys 2004; 60 (4) 1098-1105
    CrossrefPubMedGoogle Scholar
  • 66 Lezoche G, Guerrieri M, Baldarelli M , et al. Transanal endoscopic microsurgery for 135 patients with small nonadvanced low rectal cancer (iT1-iT2, iN0): short- and long-term results. Surg Endosc 2011; 25 (4) 1222-1229
    CrossrefPubMedGoogle Scholar
  • 67 Caricato M, Borzomati D, Ausania F , et al. Complementary use of local excision and transanal endoscopic microsurgery for rectal cancer after neoadjuvant chemoradiation. Surg Endosc 2006; 20 (8) 1203-1207
    CrossrefPubMedGoogle Scholar
  • 68 Guerrieri M, Gesuita R, Ghiselli R, Lezoche G, Budassi A, Baldarelli M. Treatment of rectal cancer by transanal endoscopic microsurgery: experience with 425 patients. World J Gastroenterol 2014; 20 (28) 9556-9563
    CrossrefPubMedGoogle Scholar
  • 69 Marks J, Nassif G, Schoonyoung H , et al. Sphincter-sparing surgery for adenocarcinoma of the distal 3 cm of the true rectum: results after neoadjuvant therapy and minimally invasive radical surgery or local excision. Surg Endosc 2013; 27 (12) 4469-4477
    CrossrefPubMedGoogle Scholar
  • 70 Borschitz T, Wachtlin D, Möhler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol 2008; 15 (3) 712-720
    CrossrefPubMedGoogle Scholar
  • 71 Hayden DM, Jakate S, Pinzon MC , et al. Tumor scatter after neoadjuvant therapy for rectal cancer: are we dealing with an invisible margin?. Dis Colon Rectum 2012; 55 (12) 1206-1212
    CrossrefPubMedGoogle Scholar
  • 72 De Graaf EJ, Doornebosch PG, Tollenaar RA , et al. Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention. Eur J Surg Oncol 2009; 35 (12) 1280-1285
    CrossrefPubMedGoogle Scholar
  • 73 Ptok H, Marusch F, Meyer F , et al. Colon/Rectal Cancer (Primary Tumor) Study Group. Oncological outcome of local vs radical resection of low-risk pT1 rectal cancer. Arch Surg 2007; 142 (7) 649-655, discussion 656
    CrossrefPubMedGoogle Scholar
  • 74 Lezoche E, Guerrieri M, Paganini AM , et al. Transanal endoscopic versus total mesorectal laparoscopic resections of T2-N0 low rectal cancers after neoadjuvant treatment: a prospective randomized trial with a 3-years minimum follow-up period. Surg Endosc 2005; 19 (6) 751-756
    CrossrefPubMedGoogle Scholar
  • 75 Lezoche G, Baldarelli M, Guerrieri M , et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 2008; 22 (2) 352-358
    CrossrefPubMedGoogle Scholar