Transanal endoscopic microsurgery (TEMS)

Overview

Transanal Endoscopic Microsurgery (TEM) is a minimally invasive technique used to address rectal conditions, such as tumors. In this procedure, your surgeon uses specialized instruments inserted through the anus to access the rectum, which is the lower section of the large intestine. Since there are no external incisions, patients typically experience faster recovery times and less pain compared to traditional open surgeries.

TEM enables surgeons to remove tumors located high within the rectum, which previously could only be reached through open abdominal surgery. This conventional approach involves making a large incision in the abdomen, often resulting in prolonged and uncomfortable recovery periods.

Reasons for undergoing the procedure

TEM may be a suitable choice if you have multiple health issues or are unable to undergo open surgery. This technique provides an alternative for removing colorectal cancer without requiring open abdominal surgery. TEM is also valuable for younger patients with early-stage or benign (non-cancerous) rectal tumors.

Surgeons frequently use TEM to remove growths or tumors located in the rectum. You might undergo transanal endoscopic microsurgery to treat:

• Rectal cancer
• Noncancerous (benign) rectal tumors
• Infected passageways in your rectum (fistulas)
• Rectal prolapse
• Rectal narrowing (strictures)
• Rectal polyps (small tissue growths)

Risks

Compared to open abdominal surgery, transanal endoscopic microsurgery has a reduced rate of complications. But there’s a little chance of:

• Infection
• Bleeding
• Pain in the rectum or abdomen
• Retention of urine
• Fecal urgency (an abrupt urge to defecate).

Before the procedure

There are similarities between getting ready for a colonoscopy and TEM. To provide your surgeon with an unobstructed view of your rectum, you must totally empty your bowels. Usually, you take a laxative to cleanse your colon and electrolytes to avoid dehydration.

Most likely, your doctor will advise you to:

• Don’t eat anything solid the day before surgery.
• Just consume clear liquids for the 12 to 24 hours prior to surgery.
• On the day before your procedure, stop eating and drinking by midnight.
• Make plans to spend your bowel prep at home. Additionally, your doctor might advise you to avoid taking certain drugs for several days before to the treatment, such blood thinners.

During the procedure

To maintain a sleeplike state during TEM, general anesthetic is administered to you. When performing transanal endoscopic microsurgery, your doctor:

• Inserts the rectoscope into your rectum by passing it through your anus.
• Stuffs your rectum with gas to make the tumor easier to see.
• Inserts a camera and tiny surgical tools through the rectoscope.
• Eliminates polyps or tumors together with a tiny portion of the surrounding tissue.
• Use metal clips or dissolveable stitches to reattach your rectal lining. As you heal, your body naturally reabsorbs or eliminates these stitches.

After the procedure

Not too long after the surgery, you can experience some discomfort. Within a day following surgery, you can experience:

• A catheter, or hollow tube, in your bladder to remove urine.
• An Intravenous (IV) line placed in a vein to administer fluids.
• 24 hours of Intravenous (IV) antibiotics.

After surgery, you can start eating and drinking the same day. A one- to two-day hospital stay may be required following transanal endoscopic microsurgery.

Outcome

On the day of your treatment, you are free to move around. You can get back to your regular routine as soon as you feel up to it, usually in a day or two after you get home.

After TEM, you can experience watery bowel motions for a few weeks. If necessary, you might work with a dietitian or nutritionist to modify your diet until your bowel movements are back to normal.