TRANSANAL ENDOSCOPIC MICROSURGERY
Anatomy of the rectum.
The rectum is the lower part of the colon that resides in the pelvis. It is the final location of stool before it is evacuated through the anus in the process of defecation. The rectum is an area where unfortunately polyps or a cancer can develop. In instances of most pre-cancerous lesions, a person often does not need to have a large resection of the rectum, but have it excised by an endoscope with loop and snares. Unfortunately some polyps are too large to be safely excised through endoscopy and require surgery. Classically, this is done through an open incision through a low anterior resection or abdominoperineal resection where part or the entire rectum is removed. However, sometimes only part of a wall of the rectum needs to be removed.
Transanal endoscopic microsurgery (TEM) was developed as a means to provide a good regional resection of part of the rectal wall for a pre-cancerous lesion or in resection of cancers in which the patient cannot tolerate an open surgery or has an extremely hostile abdomen that makes the resection very risky.
Transanal endoscopic microsurgery (TEM) involves the patient to be placed under complete general anesthesia. The patient is usually positioned on their back in stirrups or sometimes on their bottom. The anus is gently dilated and a metal tube is placed into the rectum.
Through the tube, air is inflated and long instruments are used to help access and cut out the abnormal polyp or tumor. The long instruments are also used to help sew the hole shut. The specimen is then sent for pathology. The procedure itself usually takes a few hours of time. The patient usually stays overnight. When they can tolerate a regular diet and have adequate pain control they usually leave in one or two days.
The advantage of TEM is that as opposed to a long hospital stay, patient recovery is much faster and are less likely to have bowel or other problems. Careful pre-operative selection is essential to make sure that the patient is an appropriate candidate for the surgery. Tumors or cancers that are very large or invasive usually are much more difficult to remove by this technique and are not considered the first option. Persons who are most appropriate for this surgery are those with large polyps that have not become cancers or early cancers in patients who have high risks with larger surgery.
Risks to the surgery are inherent but overall the procedure is less stressful and less risky to the patient than a classic partial colon resection.
Dr. Steven Gross at Regional Surgical Specialists has specialized training to perform this procedure. If you have any questions or interest in having this procedure performed as opposed to classic colon surgery please contact us at 828-252-3366.
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