March 1, 2000

TRANSANAL ENDOSCOPIC MICROSURGERY: FULL THICKNESS HEMICIRCUMFERENTIAL LOCAL EXCISION OF A MID-RECTAL LESION.

J. MARKS MD, G MARKS, MD.

The advent of Transanal Endoscopic Microsurgery (T.E.M.) in the last decade has opened new options for surgeons and patient with rectal lesions.  T.E.M. allows for transanal excision under stereoscopic vision of polyps and select cancer whose superior border extends to the mid and upper rectum.  This permits a minimally invasive resection for pathology that would otherwise require a transsphincteric, transsacral, or a low anterior resection.  Selectively utilized with adjunctive radio or chemoradiotherapy.  T.E.M. also allows for new options in the treatment for rectal cancers.  Presented is the equipment and technique of T.E.M. in a patient with a large lesion in the midrectum.  Endoscopic ultrasound staged this polyp as noninvasive. However the question of malignancy clinically still existed.  In this obese medically compromised patient, with refractory asthma on high dose steroids, a full thickness local excision and repair involving the hemicircumference of the rectum is presented, with attention to patient positioning, the technique of excision, as well as the full thickness repair. 

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