Pelvic Anatomic Considerations for Transanal Endoscopic Microsurgery
The rectum is a complex structure, protected from harm by multiple anatomic guardians. These structures not only protect the rectum from external trauma, but also make surgical access exceptionally difficult. This complex organ, essential for socially acceptable elimination of intestinal waste, is most obviously protected by the bony pelvis, but also by the anal sphincters below and by the abdominal contents above.
These protective structures, which limit surgical access to the rectum, are responsible for the development of transanal endoscopic microsurgery (TEM). If access to the rectum were unlimited, there would be no need for TEM. The inability of transanal, transsphincteric, transcoccygeal, and transabdominal approaches to provide safe, reliable exposure to allow for local excision of rectal masses is the stimulus that led to the creation of TEM in 1983. A long operating proctoscope, superior optics, specialized instrumentation, and rectal insufflation together have overcome the...
KeywordsAnal Sphincter Rectal Prolapse Transanal Endoscopic Microsurgery Pelvic Anatomy Anorectal Junction
- 6.Gordon PH, Nivatvongs S. Principles and practices of surgery of colon, rectum, and anus, 3rd edn, 2007, Informa Healthcare, New York. Google Scholar