TEM Transanal Endoscopic Microsurgery

The rectal cavity in humans is one of the most difficult regions to access from a surgeon’s perspective. Even many benign changes have to be operated on through an abdominal or sphincter-transecting port. For many years, endoscopic procedures were limited to ablations with a loop (strip biopsies) .

Transanal Endoscopic Microsurgery (TEM) is used in diseases of the colon / rectum and for their treatment. The umbrella term is designated as colorectal surgery and comprises the operations to treat benign and malignant tumors. The operations can be carried out in conventional or laparoscopic technique.
Benign diseases which require an intervention are frequently diverticular diseases. Diverticulitis is a disease of the colon. It is inflammation which results from pouches within the bowel wall. The sigmoid colon (is often affected by this disease (designated as sigmoid diverticulitis – sometimes referred to as "left-side appendicitis"). Most operations on colon and rectal tumors can be carried out laparoscopically, depending on the size and position of the tumor if the surgeon has appropriate experience.

TEM involves the operating area being visualized endoscopically using a wide-lumen rectoscope with an oblique tip. The rectoscope is anchored to the operating table using a retainer arm system to achieve stable exposure of the surgical field. The surgical procedure is carried out using a stereoscopic angled telescope which permits dissection under microsurgical conditions with 3D visualization. Up to three surgical instruments can be introduced at the same time. An additional documentation channel at the TEM stereo telescope provides video transfer for the operating team. A precondition for clear dissection is gas distension throughout the entire operation by automatic, pressure-controlled gas insufflation.  

TEM displays a number of advantages compared with conventional procedures – from local excision through TEM compared with the conventional approach with the spreader:

  • Local excision with the TEM system entails no significant access trauma. A certain amount of over-extension  of the sphincter muscle does not generally result in any adverse consequences. By comparison with the operation using the spreader, the sphincter muscle is significantly less extended.
  • TEM is possible in the area of the entire rectum.
  • The angled telescope also provides a good view behind the polyps. If the stereo telescope is used (high-end-TEM), binocular vision is possible in the entire rectum.
  • The gas distension provides an almost unrestricted view. Particularly when the surgeon is manipulating structures, e.g. when suturing, there is therefore much more freedom of movement than is the case with spreaders.

Richard Wolf has a complete, refined surgical instrument set supplied for all TEM operations, which has proved its reliability, user-friendliness and efficiency throughout the world.

Owing to the complexity of the procedure, intensive training is absolutely essential for TEM in order to be in a position to carry out operations safely. Advanced training events on this surgical procedure are held on a regular basis at the Richard Wolf Academy Prima Vista.