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Published on: February 12, 2022
Transanal endoscopic microsurgery: long-term experience, indication expansion, and technical improvements.
Daniel Léonard1, Jean-François Colin, Christophe Remue
1Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10, Avenue Hippocrate, 1200, Brussels, Belgium.
Transanal endoscopic microsurgery (TEM) is a safe and effective rectal surgery for various lesions, with low recurrence and minimal functional impact. New techniques like Harmonic scalpel and endoscopic submucosal dissection (ESD) enhance precision.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Review of 16-year experience with transanal endoscopic microsurgery (TEM).
- Assessment of mortality, morbidity, recurrence rates, and functional outcomes.
- Presentation of new indications and technical improvements in TEM.
Purpose of the Study:
- To evaluate the safety and efficacy of TEM over 16 years.
- To assess functional outcomes and recurrence rates after TEM.
- To present novel applications and technological advancements in TEM.
Main Methods:
- 123 patients underwent TEM for adenomas, adenocarcinomas, neuroendocrine tumors, and other lesions.
- Procedures included full-thickness rectal resections, excisional biopsies, pelvic abscess drainage, and rectal stricture treatment.
- Techniques evolved to include Harmonic scalpel and endoscopic submucosal dissection (ESD).
Main Results:
- No mortality; one intraoperative perforation required laparotomy.
- Postoperative complications included pneumoperitoneum and rectal perforation.
- Local recurrence rate was 7% in the polyp subgroup; pelvic abscesses and stenoses were successfully treated.
Conclusions:
- TEM is a safe and effective procedure for local rectal lesion excision.
- TEM offers low recurrence rates and minimal anorectal functional consequences.
- TEM is effective for pelvic abscess drainage and rectal stenosis treatment, enhanced by new technologies.
