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The e-mémoires of the Académie Nationale de Chirurgie

Rectal polyps resection by Transanal Endoscopic MicroSurgery (TEMS)




AbstractLow lying rectal polyps or T1 adenocarcinomas can be resected by transanal techniques (parachute or flaps), but these techniques can be used for small lesions, and up to the distal third of the rectum.TEMS, described by Buess, is a specific surgical device that allows creating a stable pneumorectum as surgical field. Laparoscopic instruments are then used to perform the endoluminal resection and sutures if necessary. A full thickness resection is thus performed with easily controlled surgical margins. Comparative studies demonstrated that TEMS is more effective than traditional transanal resections for achieving complete resections and negative surgical margins. Large lesions can be resected, and up to 10 cm anteriorly or 12 cm posteriorly from the anal verge.Morbidity is low, and peritoneal effraction can be managed either by direct suture or by laparoscopic conversion.TEMS thus allows to avoid proctectomies for benign and superficial malignant lesions of the middle and distal rectum. However, the endorectal surgical field requires a specific learning curve. In addition, published results confirm that a rigorous selection of T1 tumours is mandatory in order to preserve patients’ curability. New technical single use devices are currently available as alternatives to the initial Buess rectoscope, thus minimizing the costs.