Application of transanal endoscopic microsurgery in anorectal diseases / 中华胃肠外科杂志

Transanal endoscopic microsurgery(TEM) is a safe and effective procedure for the treatment of local tumors, especially for the rectal villous adenoma (pT0), polyps with severe dysplasia and in situ carcinoma(pTis). It can also be applied as salvage surgery for incidental carcinoma after colonoscopy as well as in cases of giant villous adenoma. With the introduction of screening colonoscopy, more early polyps will be detected. We should be able to customize our treatment accordingly. On one hand, we want to prevent overkill and on the other hand to avoid under-treatment. This article is aimed to review the development of TEM and discuss its various indications.

Treatment of rectal villous adenoma and early rectal carcinoma by transanal endoscopic microsurgery:Report of 31 cases / 中国微创外科杂志

Objective To investigate outcomes of transanal endoscopic microsurgery(TEM) for the treatment of rectal villous adenoma and early-stage rectal carcinoma.Methods A series of 31 patients with rectal tumors underwent TEM from November 1995 to December 2003.The operation was performed under general anesthesia.The patients were placed in a dependent position dictated by the location of the tumor.A special rectoscope was inserted into the anus with CO_2 insufflation to keep the rectum open.Under the stereoscope and laparoscopic-type instruments,the tumor was completely resected(submucosal or full-thickness excision) using a needle diathermy or a 5-mm ultrasonic dissector.The operative wound was closed with intra-lumen continuous sutures.Results The rectal tumor was completely removed with negative resection margins in all the 31 patients.The operating time was 45~220 min(mean,95 min) and the intraoperative blood loss was 0~180 ml(mean,40 ml).Complications included temporary flatus incontinence in 2 patients,acute retention of urine in 1 patient,exacerbation of chronic obstructive airway disease in 1,and secondary hemorrhage following Aspirin taking in 1.The postoperative pathological stages were pT_0 in 16 patients,pT_(is) in 2 patients,pT_1 in 7,pT_2 in 3,and pT_3 in 3.Follow-up checkups in the 31 patients for 2~92 months(mean,23 months) revealed no local recurrence.Conclusions TEM is a safe and effective minimally invasive surgical technique for the treatment of rectal villous adenoma and early rectal carcinoma.