title: TEM/local excision: indications, techniques, outcomes, and the future.
abstract: Transanal endoscopic microsurgery (TEM) has emerged as a safe method for excising virtually any rectal adenoma and carefully selected cancers. Extended applications include treatment of extra- and supra-sphincteric fistulae, rectovaginal fistulae, anastomotic strictures, and sinus tracts. The procedure utilizes an air-tight system, long shafted instruments, high-quality magnifying optics, and constant carbon dioxide insufflation, all of which facilitate a precise excision and closure with clear margins. Complications are few, most patients can be treated as an outpatient.
authors: Rush Medical College Head, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois, USA. eileen_j_pehanich@rush.edu
authors: Theodore J
authors: TJ
authors: Saclarides
mesh_terms: D000236:Adenoma / Q000601:surgery; D004867:Equipment Design; D005544:Forecasting; D006801:Humans; D007327:Insufflation / Q000295:instrumentation / Q000379:methods; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D020700:Proctoscopes; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography