Transanal Endoscopic Microsurgery (TEM)

  • John H. Marks


The ultimate minimally invasive procedure for intra-abdominal neoplasia is one that avoids any abdominal incision. To this end, colonoscopy with polypectomy meets the criteria and stands as the first major step in minimally invasive therapy of colorectal neoplasia. NOTES (Natural Orifice Translumenal Endoscopic Surgery) holds open the promise for just such an approach. To date the only large experience in this type of natural orifice therapy is with transanal excision of rectal polyps and select rectal cancers. Unfortunately, limited reach transanally has significantly hampered this approach. TEM has addressed this problem. Nonetheless, limited experience of surgeons has impeded the widespread adoption of this approach. In addition, concerns about the adequacy of oncologic treatment of a rectal cancer with a full-thickness excision have properly minimized acceptance of this approach. High local recurrence rates using a transanal approach have been attributed to the inability to reach the cephalad aspect of the cancer’s margin, working within the lumen potentially spreading viable cancer cells and the untreated lymphatic space.


Rectal Cancer Local Excision Local Recurrence Rate Transanal Endoscopic Microsurgery Natural Orifice Translumenal Endoscopic Surgery 
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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • John H. Marks
    • 1
    • 2
    • 3
    • 4
  1. 1.Marks Colorectal Surgical AssociatesWynnewoodUSA
  2. 2.MCP-Hahnemann UniversityWynnewoodUSA
  3. 3.Lakenau Institute for Medical ResearchWynnewoodUSA
  4. 4.Department of SurgeryLakenhau HospitalWynnewoodUSA

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