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Transanal Endoscopic Microsurgery: A Viable Operative Alternative in Selected Patients With Rectal Lesions

From the Academic Surgical Unit, University of Hull, East Yorkshire, United Kingdom.

Correspondence: Address correspondence and reprint requests to: J. R. T. Monson, MD, FRCS, FRCSI, FACS, University of Hull, Academic Surgical Unit, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, United Kingdom; Fax: 44-1482-623274; E-mail: j.r.monson{at}medschool.hull.ac.uk

Background: Local excision of rectal lesions is being increasingly undertaken, especially in those unfit for major surgery. The traditional transanal approach is often cumbersome and limited to low and mid rectal lesions. Transanal endoscopic microsurgery (TEMS) is being used to excise both benign and malignant rectal lesions, including those in the upper rectum.

Methods: Prospective analysis of all patients undergoing a TEMS excision between January 1997 and December 2000 in a specialized colorectal unit.

Results: Forty patients underwent a TEMS resection, with a mean age of 72 years (SD, 10 years). The mean distance of the lesions from the anal verge was 9.8 cm (SD, 3.1 cm). In 24 patients, the lesion was located 10 cm from the anal verge, making them unsuitable for traditional transanal resection. The mean operative time was 91 minutes (SD, 34 minutes), and the mean postoperative stay was 3 days (SD, 1.5 days). No mortality was associated with the procedure, and there was minimal morbidity in 15%. There has been no recurrence in the 18 patients who had a malignant lesion excised.

Conclusions: The TEMS operating system provides the surgeon with a suitable alternative for the resection of benign and malignant rectal neoplasms in selected patients. It has the advantage of providing visual clarity of the operative field, allowing more precise dissection and a minimally invasive approach to mid and upper rectal lesions. There has been no mortality and minimal morbidity. We advocate its inclusion as part of a colorectal surgeon’s operative armamentarium for these selected cases.

Key Words: Rectal tumors • Early rectal cancer • Local excision • Transanal endoscopic microsurgery (TEMS) • Minimally invasive

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