title: [Transanal endoscopic microsurgery (TEM). Current situation and future expectations].
abstract: Transanal endoscopic microsurgery (TEM) uses specific equipment that allows resection of large rectal adenomas and incipient malignancies in the rectal ampulla. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Application of the technique of endoanal excision is limited by the height and extension of the lesions. In this review, the authors present their own experience with this technique and that described in the literature. The protocol for selecting candidates for TEM, their preoperative preparation, equipment, characteristics of the surgical technique, postoperative complications, and follow-up are described. The collaboration of a multidisciplinary team is essential when developing this technique. TEM-associated morbidity is low and mortality is practically nil. TEM is the technique of choice in large rectal adenomas and malignant rectal tumors in stages pT1 localized in the rectal ampulla. The frequency of recurrence is similar to that in abdominal surgery. The technique does not cause complications of urinary or sexual dysfunction and fecal incontinence is minimal. In more advances stages of rectal cancer, the results of better patient selection and future studies on the possible application of neoadjuvant therapy associated with TEM are required.
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España. 22341jsa@comb.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Serra Aracil
authors.forename: Jordi
authors.initials: J
authors.lastname: Bombardó Junca
authors.forename: Laura
authors.initials: L
authors.lastname: Mora López
authors.forename: Manuel
authors.initials: M
authors.lastname: Alcántara Moral
authors.forename: Isidro
authors.initials: I
authors.lastname: Ayguavives Garnica
authors.forename: Salvador
authors.initials: S
authors.lastname: Navarro Soto
mesh_terms: D000236:Adenoma / Q000601:surgery*; D004867:Equipment Design; D005544:Forecasting; D006801:Humans; D008866:Microsurgery / Q000639:trends*; D020700:Proctoscopes; D011351:Proctoscopy / Q000379:methods / Q000639:trends*; D012004:Rectal Neoplasms / Q000601:surgery*