T.E.M (transanal endoscopic microsurgery)

TEM is a minimally invasive technique designed to ease surgical interventions in the rectum. The main indication for this technique is the treatment of benign tumours that cannot be removed by flexible endoscopy due to their size.

TEM is also used for curative purposes in the removal of malignant neoplasias in patients who present low risk T1 carcinomas (according to the Hermanek classification) In our institution TEM is used as a palliative treatment in more advanced stages, when for different reasons there is a high risk for other types of surgery.

In other occasions (rectal prolapse, carcinoids, stenosis, rectal ulcer and so on), TEM can provide an adequate alternative.

Equipment:

The basic TEM equipment consists of a rectoscopy (4 cm external diameter), which sets up a stereoscopic vision system and an optic system for videocamera.

It allows the simultaneous use of three surgical instruments.

Patients are selected through a clinic exploration, a rapid sigmoidoscopy and using a circular endorectal ecography at the pre-operatory stage.

This minimally invasive intervention holds as essential advantages the fact that it provides a neat high quality tridimensional visualisation, up to 20 cm anal margin. The dissection methods used are similar to the ones used by conventional techniques, allowing a reasonable microsurgical access to all lesions situated at a length up to 20 cm of the anal margin.

In most cases the use of TEM avoids major surgery which is not exempt from morbimortality and it provides a greater post-operational comfort and a short patient’s stay at the hospital.