[Removal of rectal adenoma with the TEM technique]

The paper presents the operation of local excision of a rectal polyp using TEM technique. The operation was performed at our Department on the 12th of April 1996 with the instruments for transanal endoscopic microsurgery made by Wolf Company according to professor Buess. The patient was 49 year old woman, in whom rectoscopy revealed at 8 cm above the dantate line a cauliflower like lesion, 3 cm in diameter, bleeding on touch and not fixed to the underlying tissues. Transrectal sonography showed the tumor was confined to the mucosa with the absence of muscularis propria infiltration. During the operation the polyp was removed with the full thickness portion of rectal wall. Wound edges were approximated with Vicryl 3-0. Histopathology confirmed villous papillary adenoma with a mild focal epithelial dysplasia. The excision was complete. The postoperative course was free of any complications and the patient being appointed for a control, was discharged from the hospital four days after the surgery. On the follow ups she presented with no complaints. When preparing the instruments, it is important to fix the apparatus properly allowing enough room for the operator's hands and getting used to the stereoscopic view. A very helpful device is the instrument for monopolar coagulation, bipolar cutting, suction and flushing, lately introduced by professor Buess.