The Colon & Rectal Clinic of Ft. Lauderdale
Charles Ternent
M.D., F.A.C.S., F.A.S.C.R.S.
Languages: English / Spanish
We exercise the most current technology on colon disease and minimally invasive procedures (MIP) in Ft. Lauderdale.
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The local excision of rectal neoplasms has been part of the practice of colorectal surgeons for many decades. The ability to safely excise a rectal neoplasm by local excision must meet specific criteria, and an extension of this technique to levels higher in the rectum is the subject of this article. Transanal Endoscopic Microsurgery (TEM) is the means by which this is accomplished. TEM is a new viable alternative for local resection of mid and proximal early rectal lesions that are too low for a sphincter preserving operation and too high for a standard instrument transanal excision.
TEM also has a role in the palliative setting and in early (pT1) rectal lesions in patients not willing to undergo an abdominal or abdominoperineal resection and may avoid the need for a stoma in selected patients. The technique is also applicable to benign polyps, carcinoid tumors and to rule out residual disease in the mid to proximal rectum. TEM excision should be viewed as a big excisional biopsy of the area in question that may need to be followed by standard radical excision, by chemo radiation or by careful follow up depending on the pathology of the resected specimen.
Professor Gerhard Buess in 1982 designed the TEM set of instruments, which he tested, modified and used clinically for excision of neoplasms of the proximal rectum. His technique quickly became widespread in Germany. The rest of Europe and the United States followed suit. The advantages of TEM include more precise excision via optics and exposure, decreased hospital stay, convalescence and pain as well as decreased morbidity and mortality. The TEM viewing piece is a stereo telescope with a 75º field of view which provides magnification with three-dimensional perception capabilities that enhance the excision of rectal lesions.
TEM is considered a form of minimally invasive endo-organ or natural-orifice surgery where the organ in question is addressed internally without the need for an abdominal or abdominal perineal incision and without the need for a colostomy. TEM is useful in selected cases where a transanal excision is not technically feasible and in cases where a low anterior resection is not the optimal surgical technique because of the pathology or comorbidities. This technology is now available at the University Hospital for selected patients with rectal neoplasms.