Advanced Surgical Techniques

  • Prakash Gatta
  • Lee L. Swanstrom


Transanal endoscopic microsurgery (TEM) has been utilized as a minimally invasive approach for low rectal lesions for over two decades. The primary indications are resection of suspicious or nonendoscopically resectable rectal polyps, early cancers or rectal ulcers. Surgeons who include TEM as a part of their practice can relate to the rather steep learning curve associated with performing this surgery for even basic resections. However, once over the learning curve, the surgeon can use TEM for a variety of more complex transanal procedures. Such advanced procedures include extended full-thickness excision, rectal sleeve resection, transanal fistula closure and, finally, TEM as a portal for natural orifice transluminal endoscopic surgery (NOTES). With the limitation of workspace within the rectum, performing more advanced procedures by TEM presents a formidable challenge to the surgeon. The surgeon should be very facile with basic TEM skills, particularly suturing. All...


Rectal Cancer Rectal Prolapse Minimally Invasive Surgery Transanal Endoscopic Microsurgery Advancement Flap 
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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Prakash Gatta
  • Lee L. Swanstrom
    • 1
  1. 1.Minimally Invasive SurgeryLegacy Health System and Oregon ClinicPortlandUSA

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