Skip to main content

Transanal Endoscopic Surgery for Benign Rectal Lesions: Preparation and Surgical Techniques

  • Chapter
  • First Online:
The SAGES Manual of Colorectal Surgery
  • 1235 Accesses

Abstract

Transanal endoscopic surgery (TES) encompasses several transanal platforms, most notably TEM and TAMIS, allowing access to the rectum for local excision of benign lesions. These techniques have been shown to improve the quality of transanal resections by allowing for improved visibility and access to the proximal rectum. This in turn provides a more complete intact specimen thereby reducing recurrence rates. Here we will discuss the indications for TES along with preoperative planning, operative setup, and technique for performing these procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Clancy C, Burke JP, Albert MR, O’Connell PR, Winter DC. Transanal endoscopic microsurgery versus standard transanal excision for the removal of rectal neoplasms: a systematic review and meta-analysis. Dis Colon Rectum. 2015;58(2):254–61.

    Article  PubMed  Google Scholar 

  2. Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H. Transanal endoscopic microsurgery. Leber Magen Darm. 1985;15(6):271–9.

    CAS  PubMed  Google Scholar 

  3. Saclarides TJ, Smith L, Ko ST, Orkin B, Buess G. Transanal endoscopic microsurgery. Dis Colon Rectum. 1992;35(12):1183–91.

    Article  CAS  PubMed  Google Scholar 

  4. Lev-Chelouche D, Margel D, Goldman G, Rabau MJ. Transanal endoscopic microsurgery: experience with 75 rectal neoplasms. Dis Colon Rectum. 2000;43(5):662–7; discussion 667–8

    Article  CAS  PubMed  Google Scholar 

  5. Cataldo PA. Transanal endoscopic microsurgery. Surg Clin North Am. 2006;86(4):915–2.

    Article  PubMed  Google Scholar 

  6. de Graaf EJ, Burger JW, van Ijsseldijk AL, Tetteroo GW, Dawson I, Hop WC. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Color Dis. 2011;13(7):762–7.

    Article  Google Scholar 

  7. Moore JS, Cataldo PA, Osler T, Hyman NH. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum. 2008;51(7):1026–30; discussion 1030–1

    Article  PubMed  Google Scholar 

  8. Maslekar S, Pillinger SH, Sharma A, Taylor A, Monson JR. Cost analysis of transanal endoscopic microsurgery for rectal tumours. Color Dis. 2007;9(3):229–34.

    Article  CAS  Google Scholar 

  9. Koebrugge B, Bosscha K, Ernst MF. Transanal endoscopic microsurgery for local excision of rectal lesions: is there a learning curve? Dig Surg. 2009;26(5):372–7.

    Article  CAS  PubMed  Google Scholar 

  10. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc. 2010 Sep;24(9):2200–5.

    Article  PubMed  Google Scholar 

  11. Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW. Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum. 2013;56(3):301–7.

    Article  PubMed  Google Scholar 

  12. Lee L, Edwards K, Hunter IA, Hartley JE, Atallah SB, Albert MR, et al. Quality of local excision for rectal neoplasms using Transanal endoscopic microsurgery versus Transanal minimally invasive surgery: a multi-institutional matched analysis. Dis Colon Rectum. 2017;60(9):928–35.

    Article  PubMed  Google Scholar 

  13. Melin AA, Kalaskar S, Taylor L, Thompson JS, Ternent C, Langenfeld SJ. Transanal endoscopic microsurgery and transanal minimally invasive surgery: is one technique superior? Am J Surg. 2016;212(6):1063–7.

    Article  PubMed  Google Scholar 

  14. Lim SB, Seo SI, Lee JL, Kwak JY, Jang TY, Kim CW, et al. Feasibility of transanal minimally invasive surgery for mid-rectal lesions. Surg Endosc. 2012;26(11):3127–32.

    Article  PubMed  Google Scholar 

  15. Barendse RM, Doornebosch PG, Bemelman WA, Fockens P, Dekker E, de Graaf EJ. Transanal employment of single access ports is feasible for rectal surgery. Ann Surg. 2012;256(6):1030–3.

    Article  PubMed  Google Scholar 

  16. Khoo RE. Transanal excision of a rectal adenoma using single-access laparoscopic port. Dis Colon Rectum. 2010;53(7):1078–9.

    Article  PubMed  Google Scholar 

  17. Watts ES, Peacock O, Gupta A, Speake WJ, Lund JN. Anyone for TAMIS? Tech Coloproctol. 2013;17(2):253–5.

    Article  CAS  PubMed  Google Scholar 

  18. Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E. Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc. 2010;24(2):445–9.

    Article  PubMed  Google Scholar 

  19. Ramirez JM, Aguilella V, Gracia JA, Ortego J, Escudero P, Valencia J, et al. Local full-thickness excision as first line treatment for sessile rectal adenomas: long-term results. Ann Surg. 2009;249(2):225–8.

    Article  PubMed  Google Scholar 

  20. Kinoshita T, Kanehira E, Omura K, Tomori T, Yamada H. Transanal endoscopic microsurgery in the treatment of rectal carcinoid tumor. Surg Endosc. 2007;21(6):970–4.

    Article  CAS  PubMed  Google Scholar 

  21. Chen WJ, Wu N, Zhou JL, Lin GL, Qiu HZ. Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors. World J Gastroenterol. 2015;21(30):9142–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002 Feb;45(2):200–6.

    Article  PubMed  Google Scholar 

  23. Lee L, Arbel L, Albert M, Atallah S, Hill J, Monson JRT. Radiologic evaluation of clinically benign rectal neoplasms may not be necessary before local excision. Dis Colon Rectum. 2018;61(10):1163–9.

    Article  PubMed  Google Scholar 

  24. Serra-Aracil X, Labró-Ciurans M, Rebasa P, Mora-López L, Pallisera-Lloveras A, Serra-Pla S, et al. Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program. Surg Endosc. 2019;33(5):1508–17.

    Article  PubMed  Google Scholar 

  25. Brown CJ, Gentles JQ, Phang TP, Karimuddin AA, Raval MJ. Transanal endoscopic microsurgery as day surgery - a single-centre experience with 500 patients. Color Dis. 2018;20(10):310–5.

    Article  Google Scholar 

  26. Arezzo A, Cortese G, Arolfo S, Bullano A, Passera R, Galietti E, et al. Transanal endoscopic operation under spinal anaesthesia. Br J Surg. 2016;103:916–20.

    Article  CAS  PubMed  Google Scholar 

  27. Bislenghi G, Wolthuis AM, de Buck van Overstraeten A, D’Hoore A. AirSeal system insufflator to maintain a stable pneumorectum during TAMIS. Tech Coloproctol. 2015;19(1):43–5.

    Article  CAS  PubMed  Google Scholar 

  28. McLemore EC, Weston LA, Coker AM, Jacobsen GR, Talamini MA, Horgan S, et al. Transanal minimally invasive surgery for benign and malignant rectal neoplasia. Am J Surg. 2014;208(3):372–81.

    Article  PubMed  Google Scholar 

  29. Coton C, Lefevre JH, Debove C, Creavin B, Chafai N, Tiret E, et al. Does trans-anal local resection increase morbidity for subsequent total mesorectal excision for early rectal cancer? Color Dis. 2019;21(1):15–22.

    Article  CAS  Google Scholar 

  30. Marks JH, Valsdottir EB, DeNittis A, Yarandi SS, Newman DA, Nweze I, et al. Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy. Surg Endosc. 2009;23(5):1081–7.

    Article  PubMed  Google Scholar 

  31. Keller DS, Tahilramani RN, Flores-Gonzalez JR, Mahmood A, Haas EM. Transanal minimally invasive surgery: review of indications and outcomes from 75 consecutive patients. J Am Coll Surg. 2016;222(5):814–22.

    Article  PubMed  Google Scholar 

  32. Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S. A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol. 2014;18(9):775–88.

    Article  CAS  PubMed  Google Scholar 

  33. deBeche-Adams T, Hassan I, Haggerty S, Stefanidis D. Transanal minimally invasive surgery (TAMIS): a clinical spotlight review. Surg Endosc. 2017;31(10):3791–800.

    Article  PubMed  Google Scholar 

  34. Ramkumar J, Karimuddin AA, Phang PT, Raval MJ, Brown CJ. Peritoneal perforation during transanal endoscopic microsurgery is not associated with significant short-term complications. Surg Endosc. 2019;33(3):849–53.

    Article  PubMed  Google Scholar 

  35. Mege D, Petrucciani N, Maggiori L, Panis Y. Peritoneal perforation is less a complication than an expected event during transanal endoscopic microsurgery: experience from 194 consecutive cases. Tech Coloproctol. 2017;21(9):729–36.

    Article  CAS  PubMed  Google Scholar 

  36. Gavagan JA, Whiteford MH, Swanstrom LL. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg. 2004;187:630–4.

    Article  PubMed  Google Scholar 

  37. Marks JH, Frenkel JL, Greenleaf CE, D’Andrea AP. Transanal endoscopic microsurgery with entrance into the peritoneal cavity: is it safe? Dis Colon Rectum. 2014;57(10):1176–82.

    Article  PubMed  Google Scholar 

  38. Issa N, Fenig Y, Yasin M, Schmilovitz-Weiss H, Khoury W, Powsner E. Laparoscopy following peritoneal entry during transanal endoscopic microsurgery may increase the safety and maximize the benefits of the transanal excision. Tech Coloproctol. 2016;20(4):221–6.

    Article  CAS  PubMed  Google Scholar 

  39. Rimonda R, Arezzo A, Arolfo S, Salvai A, Morino M. TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study. Surg Endosc. 2013;27(10):3762–8.

    Article  PubMed  Google Scholar 

  40. Lee L, Kelly J, Nassif GJ, Keller D, Debeche-Adams TC, Mancuso PA, et al. Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Surg Endosc. 2018;32(3):1368–76.

    Article  PubMed  Google Scholar 

  41. Tsai BM, Finne CO, Nordenstam JF, Christoforidis D, Madoff RD, Mellgren A. Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendations. Dis Colon Rectum. 2010;53(1):16–23.

    Article  PubMed  Google Scholar 

  42. Saget A, Maggiori L, Petrucciani N, Ferron M, Panis Y. Is there a limit to transanal endoscopic surgery? A comparative study between standard and technically challenging indications among 168 consecutive patients. Color Dis. 2015;17(7):O155–60.

    Article  CAS  Google Scholar 

  43. Allaix ME, Arezzo A, Caldart M, Festa F, Morino M. Transanal endoscopic microsurgery for rectal neoplasms: experience of 300 consecutive cases. Dis Colon Rectum. 2009;52:1831–6.

    Article  PubMed  Google Scholar 

  44. Lee L, Burke JP, deBeche-Adams T, Nassif G, Martin-Perez B, Monson JRT, et al. Transanal minimally invasive surgery for local excision of benign and malignant rectal neoplasia: outcomes from 200 consecutive cases with midterm follow up. Ann Surg. 2018;267(5):910–6.

    Article  PubMed  Google Scholar 

  45. Karakayali FY, Tezcaner T, Moray G. Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors. J Minim Access Surg. 2015;11(4):257–62.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Verseveld M, Barendse RM, Gosselink MP, Verhoef C, de Graaf EJ, Doornebosch PG. Transanal minimally invasive surgery: impact on quality of life and functional outcome. Surg Endosc. 2016;30(3):1184–7.

    Article  PubMed  Google Scholar 

  47. Jakubauskas M, Jotautas V, Poskus E, Mikalauskas S, Valeikaite-Tauginiene G, Strupas K, et al. Fecal incontinence after transanal endoscopic microsurgery. Int J Color Dis. 2018;33(4):467–72.

    Article  Google Scholar 

  48. Hompes R, Ashraf SQ, Gosselink MP, van Dongen KW, Mortensen NJ, Lindsey I, et al. Evaluation of quality of life and function at 1 year after transanal endoscopic microsurgery. Color Dis. 2015;17(2):54–61.

    Article  Google Scholar 

  49. Atallah S, Albert M, Debeche-Adams T, Larach S. Transanal minimally invasive surgery (TAMIS): applications beyond local excision. Tech Coloproctol. 2013;17(2):239–43.

    Article  CAS  PubMed  Google Scholar 

  50. Ferrer-Márquez M, Rubio-Gil F, Ortega-Ruiz S, Blesa-Sierra I, Álvarez-García A, Jorge-Cerrudo J, et al. Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions. Cir Esp. 2017;95(6):335–41.

    Article  PubMed  Google Scholar 

  51. Clerico G, Gallo G, Realis Luc A, Trompetto M. Transanal endoscopic microsurgery for perirectal dermoid cysts. Tech Coloproctol. 2017;21(4):319–20.

    Article  CAS  PubMed  Google Scholar 

  52. Gallo G, Clerico G, Luc AR, Trompetto M. Perirectal myxoid pseudocyst removed by transanal endoscopic microsurgery. Tech Coloproctol. 2016;20(11):801–3.

    Article  CAS  PubMed  Google Scholar 

  53. Banky B, Saleki M, Gill TS. Transanal endoscopic microsurgery in the management of rectal wall endometriosis. BMJ Case Rep. 2016;2016.

    Google Scholar 

  54. Suzuki T, Suwa K, Hada T, Okamoto T, Fujita T, Yanaga K. Local excision of rectal schwannoma using transanal endoscopic microsurgery: a case report. Int J Surg Case Rep. 2014;5(12):1193–6.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Liu Q, Zhong G, Zhou W, Lin G. Initial application of transanal endoscopic microsurgery for high-risk lower rectal gastrointestinal stromal tumor after imatinib mesylate neoadjuvant chemotherapy: a case report. Medicine (Baltimore). 2017;96(29):e7538.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

deBeche-Adams, T. (2020). Transanal Endoscopic Surgery for Benign Rectal Lesions: Preparation and Surgical Techniques. In: Sylla, P., Kaiser, A., Popowich, D. (eds) The SAGES Manual of Colorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24812-3_38

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-24812-3_38

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24811-6

  • Online ISBN: 978-3-030-24812-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics