Transanal Endoscopic Microsurgery (TEM)

  • Lee L. SwanstromEmail author
  • Eran Shlomovitz


The transanal endoscopic microsurgery (TEM) technique, first described by Buess nearly three decades ago (Buess et al., Chirurg 55(10):677–680, 1984), has been increasingly adopted by colorectal and minimally invasive surgeons, who are progressively incorporating this minimally invasive approach into their practice. There are currently two main platforms for performing TEM: The Richard Wolf system (Richard Wolf GmbH, Knittlingen, Germany) and the Karl Storz (KARL STORZ GmbH, Tuttlingen, Germany) transanal endoscopic operation (TEO) system. These systems were developed prior to the mainstream adaptation of laparoscopy into general surgery, in order to facilitate exposure and resection of mid and upper rectal lesions not amenable to routine transrectal techniques. Over time, modifications of the equipment have been introduced to incorporate some of the devices and lessons learned from laparoscopic surgery. This chapter will review the technique of transanal endoscopic microsurgery in detail. Additionally, indications, patient preparation, and equipment setup will be briefly reviewed.


Transanal Endoscopic Microsurgery (TEM) Minimally invasive surgery Colorectal surgery 

Supplementary material

Video 26.1

Marking around lesion (MP4 13143 kb)

Video 26.2

Submucosal injection (MP4 5946 kb)

Video 26.3

Submucosal dissection (MP4 22816 kb)

Video 26.4

Full-thickness dissection (MP4 24197 kb)

Video 26.5

Stay suture and clip placement (MP4 30644 kb)

Video 26.6

Closure of right of stay suture proximal to distal (MP4 22512 kb)

Video 26.7

Closure left of stay suture distal to proximal (MP4 27104 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Minimally Invasive Surgery DivisionProvidence Portland Medical Center, The Oregon ClinicPortlandUSA

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