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Related Experiment Video

Updated: Mar 24, 2026

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The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance.

R M Helewa1, A N Rajaee2, I Raiche2

  • 1Department of Surgery, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada. rhelewa@toh.on.ca.

Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland
|March 19, 2016
PubMed
Summary

Surgeons improve transanal endoscopic microsurgery (TEM) efficiency within 16 cases. Younger age, fewer than five prior cases, and specific tumor histology predict longer operative times in new TEM programs.

Keywords:
Transanal endoscopic microsurgerysurgical efficiencysurgical performance

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Surgical Education

Background:

  • Transanal endoscopic microsurgery (TEM) has been available for over 30 years, yet its adoption remains slow in many centers.
  • There is limited research on the learning curve and early performance of surgeons initiating TEM programs.

Purpose of the Study:

  • To identify predictors of operative time and assess improvements in surgical efficiency for a new TEM program.
  • To understand factors influencing the learning curve in transanal endoscopic microsurgery.

Main Methods:

  • Retrospective chart review of 108 patients undergoing TEM between 2009 and 2014.
  • Calculation of Average Rate of Excision (ARE) (min/cm³) to measure surgical efficiency.
  • Multivariable regression analysis to identify predictors of higher ARE.

Main Results:

  • Surgical efficiency (ARE) improved significantly up to 16 cases.
  • Younger age (<50 years), fewer than five prior TEM cases, and specific histology (carcinoid/GIST or scar) were associated with longer operative times.
  • The mean ARE was 18.6 min/cm³ among 95 patients with available data.

Conclusions:

  • Surgical efficiency in TEM improves with experience, reaching a plateau after approximately 16 cases.
  • Factors such as patient age, surgeon experience, and tumor histology significantly impact operative time.
  • Findings have implications for surgical training and planning for new TEM programs.