What does TEM consist of?
Transanal endoscopic microsurgery (TEM) is a procedure that uses specific equipment in order to excise large rectal adenomas and incipient cancers in the rectal ampulla.
Reason for TEM
TEM is an alternative to conventional abdominal surgery with a high morbimortality (anterior Low resections or abdominoperineal amputation). It also overcomes the limitations of resections performed with endoscopy or conventional transanal surgery and improves the short and long term results.
Patients with the following pathologies:
- Rectal adenomas: tubular, villous or tubulovillous adenomas not amenable to endoscopic resection.
- Early-stage adenocarcinomas (T0-1, N0).
- Rectal carcinoma (any stage) in high-risk patients. Some patients require a personal and multidisciplinary study involving radiotherapeutic experts, oncologists and surgeons for the use of this technique, for example intermediate-stage adenocarcinomas (T2, N0).
Preparation for this procedure
For the correct selection of patients, it is essential to provide an adequate medical record with a rectal exam and a complete colonoscopy with a biopsy..
Other necessary complementary tests for the stage assessment include: endorectal ultrasound (it gives precise information on the local extension and indicates the presence of adenopathies) and pelvis MRI scan (complementary to the previous technique).
In case of patients with adenocarcinoma results, thoracoabdominal CT, PET-CT and tumor marker studies are necessary in order to discard distant affection.
It is necessary to proceed with a preoperative preparation which includes mechanical cleaning of the colon as well as antibiotic and thromboembolic prophylaxis.
The position of the patient on the operating table depends on the location of the injury. The intervention begins with the endoanal placement of a specific rectoscope with working channels that allow the excision of rectal injuries. It is essential to keep a good CO2 insufflation system in the rectum (pneumorectum), a procedure which is performed through TEM..
Postoperative process with hospital stay no longer than 72 hours if no complications arise.
- 40 mm, 4-channeled rectoscope
- Digital insufflator in order to support the pneumorectum
- Graspers, needle holders, clip holders and scissors
- Ergonomic suction pump
- Monopolar and ultrasonic scalpels
- Topographic limitations: injuries located in the rectum at 20 cm depth or more anteriorly and/or 15 cm depth or more posteriorly or laterally.
- Morphological limitations: spiral injuries with a wide circumference (partial limitation) and/or initial adenocarcinomas over 3 cm.
- Oncologic limitations: late-stage rectal tumors with curable possibilities (T3-4, N+).
- Greater control in the endoanal resection with better oncologic results (complete rectal wall excision).
- Reduction of relapses.
- Reduction of ostomies (protective ileostomies or definitive colostomies).
- Shorter hospital stay.
- Reduction of morbimortality due to its minimally invasive nature.
Monitoring after surgery
Periodic controls by specialists on:
- Digestive system
- Oncology, if needed