Equipment and Operative Set-up
The equipment for transanal endoscopic microsurgery (TEM) was designed in the early 1980s well prior to the advent of therapeutic laparoscopy for general surgery, and was developed to overcome the problem of exposure and access to the upper two thirds of the rectum. Owing to the nature of rectal anatomy, the operating proctoscopes and instruments are long and narrow. The insufflation/suction/irrigation machine provides the exposure necessary to carry out the cutting, dissecting, and sewing required. The equipment is fitted with locking gaskets and caps to maintain a gastight system, thus keeping the rectum insufflated to facilitate operative exposure.