What is transanal endoscopic microsurgery (TEM)?

Transanal endoscopic microsurgery (TEM) is used to remove polyps and early cancers of the rectum.
Transanal endoscopic microsurgery (TEM) is used to remove polyps and early colorectal cancer.

Transanal endoscopic microsurgery (TEM) is an advanced surgical procedure performed through the anus to remove polyps and early cancers of the rectum (end of the large intestine or anal area) using specially designed microsurgical instruments through the anus. 

This technique avoids a major abdominal operation. The recovery time is greatly reduced for this procedure. In very rare cases, patients might require an artificial opening called stoma, which is usually closed after the anal area is healed.

This procedure is usually performed under general anesthesia. TEM is performed through the patient’s anus. The surgeon precisely removes the polyp or small cancers, leaving the surrounding healthy tissue intact. In most cases, the healthy edges of the rectal lining are stitched together using dissolvable sutures. These are either absorbed or expelled from the body naturally. 

After the surgery, patients may need to stay in the hospital for one or two days. Most patients feel some discomfort, though rarely pain, in the back passage. 

After two days, patients may start on a liquid diet and gradually introduce solid foods. It is usually recommended that patients move around as soon as possible following the surgery. Patients may pass liquid stools for a few days. 

Sometimes, it takes several weeks to get back to normal; in some cases, patients may have to adjust their diets.

What are the complications of transanal endoscopic microsurgery (TEM)?

Serious complications after transanal endoscopic microsurgery (TEM) are rare.

  • Patients may have fever, pain and bleeding for a few days. They may be on intravenous liquids along with painkillers.
  • Infection at the site of sutures. Patient are usually on antibiotics to prevent infection
  • Intestine perforation
  • Problems with artificial opening.

What is transanal minimally invasive surgery (TAMIS)?

Transanal minimally invasive surgery (TAMIS) is a hybrid version of the transanal endoscopic microsurgery (TEM).

  • The surgeon usually uses standard laparoscopic instruments to remove a polyp or superficial lesion through the anus, without making an incision. The procedure is usually performed under general anesthesia.
  • During TAMIS, the surgeon places a specialized laparoscopic surgery port into the anus. They pass the laparoscope and other needed instruments through the port to the rectum, where they remove the polyp. Once the lesion is removed, the surgeon sutures the hole in the rectum.
  • This procedure allows surgeons to remove polyps that are too large or too flat to be removed through the other procedure. 
  • The biggest drawback of TAMIS is that the lymph nodes cannot be assessed for cancer spread, so the procedure is only used for patients with very early-stage rectal cancer.
  • Recovery is significantly better after TAMIS than that after other procedures.

Which procedure is considered for removing polyps and early cancers of the rectum?

Transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) work on similar methods and principles. TAMIS is a safe and effective procedure for treating rectal cancers and can be performed without impairing anorectal functions. The major drawback of TEM is that it requires expensive, highly specialized equipment. 

However, TAMIS offers several benefits over TEM because it requires minimal setup time, and the use of existing laparoscopic cameras and instruments offers a lower cost. Hence, TAMIS is usually considered to remove polyps or early cancers of the rectum.

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Medically Reviewed on 7/29/2020
References
"Transanal Endoscopic Microsurgery (TEM) and Transanal Minimally Invasive Surgery (TAMIS)"

Medscape Medical Reference
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