Getting Started

  • Patricia L. Roberts

Transanal endoscopic microsurgery (TEM) was developed by Buess in 1983 and involves the use of specialized equipment to remove selected rectal cancers and polyps [1]. The equipment involves an operating proctoscope, insufflation, and magnified stereoscopic vision to improve visualization and facilitate more precise excision. Although there are approximately 430 TEM systems in use worldwide, there are only approximately 45 active units in the USA. Adoption of the technique of TEM has been slow in the USA probably because of the cost of the unit and the challenges of adequate training [2]. Despite these challenges, the improved visualization and optics of TEM combined with the ability to remove lesions throughout the rectum appear to have ensured the role of TEM in the surgeon’s armamentarium. This chapter reviews the steps in beginning a TEM program, including the decision to pursue TEM equipment, training, the early experience, and the learning curve.

Deciding To Pursue Transanal...


Rectal Cancer Transanal Endoscopic Microsurgery Rectal Polyp Transanal Excision Operating Room Staff 
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  1. 1.
    Buess G, Gunther M. Endoscopic operative procedures for the removal of rectal polyps. Coloproctology 1984;6:254.Google Scholar
  2. 2.
    Saclarides TJ. Transanal endoscopic microsurgery. Seminars in Laparoscopic Surgery 2004;11:45–51.PubMedGoogle Scholar
  3. 3.
    Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aquilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 2000;43(8):1064–71.CrossRefPubMedGoogle Scholar
  4. 4.
    Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 2001;44(9):1345–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Guillem JG, Chessin DB, Jeong SY, Kim W, Fogarty JM. Contemporary applications of transanal endoscopic microsurgery. Clinical Colorectal Cancer 2005;5(4):268–73.CrossRefPubMedGoogle Scholar
  6. 6.
    Cataldo PA. Transanal endoscopic microsurgery. Surg Clin N Am 2006;86:915–925.CrossRefPubMedGoogle Scholar
  7. 7.
    Casadesus D. Transanal endoscopic microsurgery: a review. Endoscopy 2006;38:418–423.CrossRefPubMedGoogle Scholar
  8. 8.
    Saclarides TJ. Transanal endoscopic microsurgery:a single surgeon’s experience. Arch Surg 1998;133:595–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Dafnis G, Pahlman L, Raa Y, Gustafsson UM, Graf W. Transanal endoscopic microsurgery:clinical and functional results. Colorectal Disease 2004:6:336–42.CrossRefPubMedGoogle Scholar
  10. 10.
    Cataldo PA, O’Brien S, Osler T. Transanal endoscopic mircrosurgery: a prospective evaluation of functional results. Dis Colon Rectum 2005;48:1366–71.CrossRefPubMedGoogle Scholar
  11. 11.
    Ganai S, Garb JL, Kanumuri P, Rao RS, Alexander AI, Wait RB. J Gastrointest Surg 2006;10:22–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Michel LA. The epistemology of evidence-based medicine. Surg Endosc 2007;21:145–51.CrossRefPubMedGoogle Scholar
  13. 13.
    American Society of Colon and Rectal Surgeons. Position statement. Laparoscopic colectomy for curable cancer. Available at accessed March 3, 2007.

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Patricia L. Roberts
    • 1
  1. 1.Tufts University School of Medicine, Boston, MA, Lahey ClinicBurlingtonUSA

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