Transanal Endoscopic Microsurgery

  • Lee E. Smith


The treatment of small cancers of the rectum has been a standard of practice for decades. However, because of difficult exposure, only the distal third of the rectum could be approached with standard instruments. To overcome the lack of ability to see in the middle and upper thirds of the rectum, different strategies had to be invented. Kraske1 tried to enter the posterior aspect of the rectum through a parasacral incision, which often necessitates the removal of the coccyx bone. York-Mason2 incised the sphincter mechanism to reach well up into the rectum. Unfortunately, the sphincter muscle must be reapproximated very precisely to preserve continence. A more recent approach has been to introduce an operating proctoscope that has a large diameter. This approach has been tried for electrocoagulation of neoplasms or excisions. In Germany in the early 1980s Gearhart Buess developed a set of long proctoscopes through which carbon dioxide could be insufflated. Long operating instruments, a binocular microscope and an insufflating machine are also required. This set of equipment has been termed a transanal endoscopic microsurgery (TEM) unit. This technique has flourished in Europe where many surgeons have taken time to learn this difficult skill. In the United States the acceptance has been much slower, probably because it is quite difficult to learn and requires much practice, and the instrument set is expensive.


Local Excision Needle Holder Clip Applier Face Plate Silver Clip 
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© Springer Science+Business Media New York 2001

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  • Lee E. Smith

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