[Standardized development of transanal endoscopic microsurgery]

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Endoscopic Procedures

Background:

• Transanal endoscopic microsurgery (TEM) is a unique one-port endoscopic system enabling direct endoluminal access through natural openings.
• Applied in colorectal surgery for over 30 years, TEM offers advantages like quicker recovery, shorter hospital stays, and reduced complications compared to radical surgery.

Purpose of the Study:

• To introduce the standardization of TEM, its current indications, novel implications, and future perspectives.
• To discuss the essential components of a TEM surgical system: rectoscope, instruments, and imaging.
• To highlight the importance of preoperative evaluation, including digital examination, sigmoidoscopy, and advanced imaging like MRI and ERUS for rectal tumors.

Main Methods:

• Review of TEM surgical system components and their role in standardization.
• Analysis of preoperative evaluation techniques for accurate staging.
• Discussion of endoluminal suturing challenges and the need for professional training.
• Compilation of expert consensus on TEM indications formulated in 2016.
• Examination of the expanding scope of TEM applications.

Main Results:

• TEM system comprises a specialized rectoscope, surgical instruments, and an imaging system, crucial for standardization.
• Accurate preoperative assessment, including digital rectal exam, sigmoidoscopy, ERUS, and MRI, is vital for successful TEM.
• Recommended TEM indications include rectal adenomas, early rectal cancer, polyp resection, benign strictures, anastomotic leakage repair, hemorrhage diagnosis, biopsy, rectovaginal fistula repair, and foreign body removal.
• TEM technology is evolving, with current applications including neuroendocrine tumors, GIST resection, and rectovaginal fistula repair.
• TEM serves as a platform for transanal total mesorectal excision (taTME).

Conclusions:

• Standardization of TEM requires a robust surgical system, precise preoperative evaluation, and mastery of techniques like endoluminal suturing.
• The established indications for TEM are broad, encompassing various benign and malignant rectal conditions.
• Ongoing technological advancements are expanding TEM's applicability, including its role in complex procedures like taTME.
• Further popularization and healthy development of TEM in China are anticipated.