Transanal endoscopic microsurgery TAMIS – TEM
Transanal endoscopic surgery is an endoscopic technique (TAMIS transanal minimally invasive surgery, TEM transanal endoscopic microsurgery) with which large rectal polyps with dysplasia or malignant tumors in their initial stage (T1N0M0) are removed by surgery from the anus without incisions.
Using laparoscopic tools, the tumor is removed along with the corresponding part of the intestine and then the opening is sutured. Cure rates are comparable to conventional surgery in well-selected cases.
Hospitalization is usually 24-48 hours and the patient is discharged with simple instructions.
This method, together with the transsphincteric resection, constitutes the modern treatment for rectal cancer without a permanent unnatural seat (colostomy, pouch).
Indications for Transanal Endoscopic Surgery:
1) Large rectal polyps with dysplasia
2) Stage T1N0M0 rectal cancer with good or moderate differentiation
3) Tumor size up to 4cm and less than 40% of the perimeter
4) No suspicion of lymph nodes by MRI
5) Volume distance >4cm from ring and <20cm
The following video shows the resection of a rectal adenocarcinoma in an 86-year-old man at a distance of 8 cm from the ring. The dimensions of the area where the full-thickness excision was performed are 3.8X3.6cm and it is in an anterior position (towards the prostate area). The patient was discharged in 48 hours and his biopsy showed complete removal of the tumor. With this method, the patient avoided a much heavier operation (colectomy) and the possibility of an unnatural seat.