Complications of transanal endoscopic microsurgery (TEMS): a prospective audit

Bignell, Mark; Ramwell, A; Evans, John R.; Dastur, Neville; Simson, J. N. L.

doi:10.1111/j.1463-1318.2009.02071.x

Cited by 61 publications

(56 citation statements)

References 24 publications

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“…Our figures are found to be within the range published by other series (2% -30%) [21,[24][25][26][27][28][29], being mostly minor complications which are solved with conservative treatment. Although urinary retention is the most common complication in other studies, our main postoperative complication was bleeding, which presented in three patients, one of whom required surgical revision.…”

Section: Discussionsupporting

confidence: 77%

Transanal Endoscopic Microsurgery (TEM) for Rectal Neoplasms

Ferrer-Márquez¹,

Reina-Duarte²,

Rubio-Gil³

et al. 2012

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Introduction:The abdominal approach for the treatment of rectal tumors is associated with a considerable rate of morbidity. Transanal Endoscopic Microsurgery (TEM) is an alternative technique that is less invasive than radical surgery, and therefore has a lower associated morbidity. Moreover, with proper patient selection, TEM presents oncological outcomes comparable to radical surgery. The aim of this study is to review our results obtained with TEM and discuss its role in the treatment of malignant rectal lesions. Patients and Methods: A prospective descriptive study from June 2008 until February 2011. The indications for TEM were: early rectal neoplastic lesions (T 1 N 0 M 0 ) with good prognostic factors; neoplastic lesions in more advanced stages in selected patients (high surgical risk, refusal of radical surgery or stoma, and palliative intention). Results: Resection by TEM was performed on 19 patients. The average hospital stay was 5.7 days with an associated morbidity of 16.7%. R 0 resection was 88.8%. During the follow-up of 15 (3 -31) months, no recurrence has been shown. Conclusions: TEM is a safe and effective procedure for the treatment of selected early malignant rectal lesions and is associated with low morbidity. It is a therapeutic strategy based on a multidisciplinary team, careful patient selection, an audited surgical technique and a strict follow-up protocol.

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Section: Discussionsupporting

confidence: 77%

Transanal Endoscopic Microsurgery (TEM) for Rectal Neoplasms

Ferrer-Márquez¹,

Reina-Duarte²,

Rubio-Gil³

et al. 2012

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“…Postoperative complications are rare following TEM, and include postoperative bleeding (1.7-2.7%) and pelvic sepsis due to perforation (1-2.7%). The mortality associated with TEM is low (0-2%) (27). Surgical emphysema following TEM is a very rare complication (28).…”

Section: Discussionmentioning

confidence: 99%

Transanal minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

Noura

Ohue

Miyoshi

et al. 2016

Molecular and Clinical Oncology

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Abstract. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique. However, TEMhas not yet achieved widespread use. Recently, transanal minimally invasive surgery (TAMIS) using single-port surgery devices has been reported. In the present study, TAMIS using a GelPOINT ® Path was performed in six patients with lower rectal cancer. A complete full-thickness excision was performed in all cases. The patient characteristics, operative techniques and operative outcomes were evaluated. The mean age of the patients was 63.0 years (range: 48-76). The mean operating time and blood loss were 86 min (range: 55-110) and 5 ml (range 0-10), respectively. There were no instances of morbidity or mortality. Additional transabdominal rectal resection was not performed, and adjuvant chemoradiotherapy was performed in all cases. The mean Wexner score was 0.6 (range: 0-3; n=5) at 6 months, and 0 (range: 0; n=4) at 12 months. TAMIS using a GelPOINT ® Path was revealed to be easy and safe to perform. Although only a small number of cases were treated, the anal function following surgery was shown to be favorable, and the operation was demonstrated to be sufficiently feasible. Based on these results, TAMIS may, in time, assume a major role in the resection of large adenomas and early rectal cancers. IntroductionThe rectum is a challenging area for surgeons to operate on due to its limited access. Although advances in conventional surgery have broadened the choice of sphincter-preserving procedures, definitive colostomy is still necessary in 10-30% of patients (1). Furthermore, the postoperative morbidity and mortality rates remain high (2). Besides urinary dysfunction, the disturbance of bowel function proves a major problem in ~30% of patients (3,4).Benign neoplasia and early-stage rectal cancer located in the rectum have been traditionally managed with transanal excision (TAE) using a conventional instrument, such as a Parks retractor. This approach, however, has several limitations, as exposure and visibility within the rectal lumen curtail the surgeon's ability to perform a high-quality oncological excision. Since the introduction of transanal endoscopic microsurgery (TEM), which was first described by Buess et al (5), TEM has become the treatment of choice for benign lesions and early-stage cancers that are not suited to TAE using a conventional Parks retractor or flexible endoscope (6,7). TEM has also become a valuable option in selected patients with malignant rectal disease, in whom it may provide an acceptable oncological outcome with minimal postoperative morbidity and an improved functional outcome compared with standard radical resection (8,9). However, nearly 30 years after the introduction of TEM, this transanal platform has not achieved widespread adoption due to the cost and the complexity of the instruments, the steep learning curve and the requirement of specialized training to master the operation (10,11).Although the instruments and procedures that are used in resection with TEM have remained largel...

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“…In fact, as reported in literature some authors consider the closure of the defect of the rectal wall after TEM excision as well as an essential step of the procedure, but in contrast, other authors do not consider this step mandatory in all cases. 3,10 Moreover, another important aspect, that can influence the chose to administer or not the antibiotics therapy postoperatively, could be the neoadjuvant chemo-radiotherapy (n-CRT). 3 In the Chen's et al article, patients who underwent to n-CRT are not reported, 1 even if, recently, it is possible to observe a fast increase of association of neoadjuvant therapy and transanal procedures (with TEM or other platforms).…”

Section: In Clinical Values Of Preoperative Use Of Antibiotics Inmentioning

confidence: 99%