Name of the Procedure:

Excision of Rectal Tumor, Transanal Endoscopic Microsurgical Approach (TEMS), including Muscularis Propria (Full Thickness)

Summary

The Transanal Endoscopic Microsurgical Approach (TEMS) is a minimally invasive procedure used to remove rectal tumors. This technique is performed through the anus, allowing for precise removal of the tumor, including the muscularis propria layer, without the need for major abdominal surgery.

Purpose

TEMS is used to treat rectal tumors, both benign and malignant, that are accessible via the rectum. The primary goal is to completely remove the tumor, reducing the risk of recurrence and addressing symptoms such as bleeding or obstruction.

Indications

• Presence of benign rectal tumors such as adenomas.
• Early-stage rectal cancer (T1 or T2) where the cancer is confined to the rectal wall.
• Symptoms such as rectal bleeding, pain, or bowel obstruction.
• Patients who are not suitable candidates for major abdominal surgery due to comorbid conditions.

Preparation

• Patients may be advised to follow a specific diet and bowel preparation regimen to clear the rectum.
• Fasting for at least 8 hours before the procedure.
• Stopping certain medications like blood thinners, as per doctor’s advice.
• Pre-procedure diagnostics such as a colonoscopy, MRI, or rectal ultrasound to assess the tumor.

Procedure Description

1. The patient is given general or regional anesthesia.
2. A specialized endoscopic instrument is inserted through the anus.
3. The surgeon uses the instrument, which provides a magnified view of the rectum, to excise the tumor with precision.
4. The tumor is removed along with a margin of healthy tissue, including the muscularis propria layer.
5. The excised tissue is retrieved for histopathological examination to ensure complete removal.
6. The surgical site may be sutured or left to heal naturally, depending on the specifics of the case.

Duration

The procedure typically takes 1 to 2 hours, depending on the size and complexity of the tumor.

Setting

TEMS is usually performed in an outpatient surgical center or hospital.

Personnel

• Colorectal surgeon specialized in endoscopic microsurgery.
• Anesthesiologist.
• Surgical nurses and technician assistants.

Risks and Complications

• Bleeding.
• Infection.
• Perforation of the rectal wall.
• Stricture formation.
• Temporary incontinence or difficulty with bowel movements.

Benefits

• Preserves normal rectal function better than traditional surgery.
• Less postoperative pain.
• Quicker recovery and shorter hospital stay.
• Lower rate of complications compared to open surgery.

Recovery

• Monitoring in the recovery room until anesthesia wears off.
• Pain management with medications as needed.
• Resuming normal activities within a few days.
• Avoiding heavy lifting or strenuous activity for a few weeks.
• Follow-up appointment to monitor healing and discuss biopsy results.

Alternatives

• Traditional open or laparoscopic surgery may be considered for larger or more invasive tumors.
• Radiation or chemotherapy may be recommended for specific cases.
• Endoscopic submucosal dissection (ESD), another minimally invasive option but often more complex.

Patient Experience

During the procedure, patients will be under anesthesia and will not feel pain. Post-procedure, they may experience mild discomfort or a feeling of fullness in the rectum. Pain can usually be managed with over-the-counter pain relievers. Most patients can return to normal activities relatively quickly, typically within a few days to a week, with instructions to follow up with their healthcare provider for any concerns.