title: Transanal endoscopic microsurgery for the resection of submucosal and retrorectal tumors.
abstract: BACKGROUND
  Transanal endoscopic microsurgery (TEM) was originally designed for local endoscopic excision of benign and low-grade mucosal rectal lesions through an endoscopic system. The procedure is particularly challenging for submucosal and retrorectal lesions, as the tumor margins are not well defined.
  
  
  OBJECTIVE
  To investigate patient and surgical characteristics of TEM as a treatment for submucosal rectal and retrorectal lesions.
  
  
  METHODS
  All the patients in our department of general surgery who underwent TEM for a submucosal rectal or retrorectal lesion, between the years 2001 and 2011, were identified. Their charts were reviewed and data pertaining to demographic characteristics and medical history, including tumor characteristics, were collected. Operative notes and histopathology reports were also reviewed. The adequacy of the tumor resection, that ism attainment of free margins, endoscopic completion of the procedure, and perioperative complications, were assessed.
  
  
  RESULTS
  Fifteen patients (5 females, 10 males), mean age 53.9 ± 16.9 years, were identified. The main indications for surgery were gastrointestinal stromal tumor (5 patients) and tailgut or duplication cyst (4 patients). All procedures were completed endoscopically. The median distance from the anal verge was 7.3 cm (range, 5 to 10 cm), and the mean diameter of the tumors was 3 ± 1.1 cm. The one patient in whom the margins presented tumoral involvement underwent repeated TEM. No intraoperative complications were reported. The postoperative complication rate was 13.3%, and the mean length of hospital stay was 1.85 ± 1.77 days.
  
  
  CONCLUSIONS
  TEM for retrorectal and submucosal rectal lesions is feasible and safe. A remarkably low morbidity rate and limited surgical injury favor TEM in selected patients.
authors: Department of General Surgery, Rambam Health Care Campus, Bruce Rappaport Medical School, Technion, Haifa, Israel. d_duek@rambam.health.gov.il
authors: Simon-Daniel
authors: SD
authors: Duek
authors: Yoram
authors: Y
authors: Kluger
authors: Shahar
authors: S
authors: Grunner
authors: Avi A
authors: AA
authors: Weinbroum
authors: Wisam
authors: W
authors: Khoury
mesh_terms: D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*