Transanal endoscopic microsurgery

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In the transanal endoscopic microsurgery (abbr .: TEM) is a minimally invasive surgical technique , mainly for the removal of adenomas and small carcinomas in the lower rectum is suitable ( "rectum").

execution

Under general or spinal anesthesia, the patient is placed in lithotomy position on the operating table . A 40 to 50 mm thick, rigid rectoscope is inserted through the anus, the operating area is set and the device is fixed to the table. The view of the operating area is maintained by inflating the intestine with a slight excess pressure. The operation is carried out via gas-tight working channels with fine special instruments under a magnifying glass or camera. Adenomas and small carcinomas can be resected in this way , whereby the wall defect is covered with a suture.

indication

Adenomas

Adenomas, i.e. benign polyps in the lining of the large intestine, are facultative precancerous diseases , i.e. precursors to malignant diseases. This applies in particular to a special type of tissue, the tubulovillous adenoma. Therefore, adenomas that are found during a colonoscopy are removed using a diathermic snare wherever possible . This does not succeed in some cases, depending on the location of the adenoma, its size and the width of its base. If these adenomas are located in the area of ​​the large intestine that is easily accessible from the free abdominal cavity, they can usually be removed with relatively simple operations (wall resection or removal of a short section of the large intestine) without great effort. In the rectum, access from the free abdominal cavity is severely restricted, and the risk of surgery is significantly increased. In the case of an adenoma located only a few centimeters from the anus, in extreme cases a rectal amputation with the creation of a permanent artificial intestinal outlet ( anus preter ) would have to be carried out.

Since adenomas are always limited to the mucous membrane ( mucosa ) of the intestine, it is sufficient to remove this mucosa without removing the muscle layer ( muscularis ). The advantage for the patient lies in the significantly lower risk of surgery, less physical stress caused by the operation and faster convalescence.

Carcinomas

In the case of rectal carcinomas in a very early stage ("carcinoma in adenoma", "carcinoma in situ", "T1 carcinoma"), local excision of the tumor in the sense of a "mucosectomy" (removal of the mucous membrane) or full-thickness excision is sufficient. The rectum is particularly easily accessible to endoscopic ultrasound , so that these locally removable tumors can be reliably detected preoperatively. The subsequent histological examination of the removed tissue ensures sufficient excision.

history

The TEM was developed and presented in 1984 by Gerhard Buess . It has been widely used since the 1990s and is now offered in a variety of visceral surgery and coloproctology departments.

Individual evidence

  1. G. Bueß, F. Hutterer, J. Theiss, M. Böbel, W. Isselhard, H. Pichlmaier: The system for transanal endoscopic rectum surgery. In: surgeon. Vol. 55, 1984, pp. 677-680.