Transanal endoscopic microsurgery
What is it?
What is it?If a suspicious lesion in the rectum might still be a benign polyp, a local resection (i.e. removal) may be opted for. In this case, the tumour is removed through the anus with a narrow margin. In case of smaller lesions, resection can be done immediately during the colonoscopy.
Larger lesions sometimes require surgical intervention through the anus. We call this a transanal endoscopic microsurgical resection or TEM. Based on microscopic examination of this large biopsy, a definitive diagnosis can be reached. If it proves to be a benign polyp, its total removal is usually sufficient. Further treatment with more extensive surgery, adjuvant radiotherapy or chemotherapy is then not required.
Process
ProcessTransanal endoscopic microsurgery or TEM is an operation where you are placedunder general anaesthesia. The surgeon inserts a rigid working channel into the rectum through the anus. Through this tube, the rectum is inflated using carbon dioxide. With the assistance of a 3D camera inserted through the access tube, a wide excision of the suspected lesion can be performed using fine elongated instruments.
This technique allows for the full-thickness removal of the lesion from the rectal wall. Pathologists examining the specimen microscopically can thus perfectly describe the depth of growth in the wall afterwards.
After the resection (i.e. removal), the remaining defect in the wall of the rectum can be closed with sutures. For larger wounds, this is not technically possible. The defect will then gradually heal spontaneously. Prior to surgery, an enema is usually administered to cleanse the intestines. This improves vision during the surgery. It also means there are fewer infections after the procedure.
Possible complications
Possible complicationsPost-operative discomfort or several complications may occur after a TEM:
As the rigid tube remains in place throughout the procedure, the sphincter is stretched for a long time. This sometimes results in temporary, relative weakness of the sphincter after the procedure. As a result, infrequent unintentional loss of gas may occur. This discomfort is usually resolved very quickly.
For the same reason, some patients have a sense of swelling of the anus similar to having haemorrhoids after the procedure. This pressure will also resolve naturally.
Severe pain is generally absent. However, this is possible when the resection was around the lower section of the rectum (the mucous membrane is a lot more sensitive in this area).
Because a wound is created on the inside of the rectum during this procedure, internal bleeding may occur. This subsequent bleeding is a possibility especially when the wound defect is left open. Discrete blood loss in the stools is a regular occurrence in the first few days. This is not a cause for concern.
If the internal wound was closed with sutured, an infection producing pus may develop beneath the sutures. The pus is generally evacuated spontaneously through the anus. In exceptional cases, the abscess may spread into the abdominal cavity. In case of fever or stomach pain in the days after the procedure, it is best to get in contact for further tests (such as blood tests and a CTscan).
Results
ResultsThe subsequent approach after the transanal removal of a tumour depends mainly on the findings of the microscopic examinations.
If the lesion was of no concern and the resection margin was sufficiently large, this procedure suffices in most cases. In this case, it is enough to monitor the through endoscopy (with the endoscope, a camera used to view the inside of the body).
If a deeper, malignant tumour was diagnosed or if the resection (i.e. removal) turned out to be inadequate, further steps must be taken. Depending on the situation, the team of physicians may opt for an additional operation (removal of rectum) and/or radiation of the rectum.
Centres and specialist areas
Centres and specialist areas
Latest publication date: 16/05/2024
