title: Transanal endoscopic microsurgery as an outpatient procedure is feasible and safe.
abstract: BACKGROUND
  Transanal endoscopic microsurgery (TEM) for the excision of rectal tumor is mostly performed as an inpatient procedure. The aim of this study was to assess the feasibility and safety of TEM resection as an outpatient procedure in selected patients.
  
  
  METHODS
  All first 178 consecutive patients who underwent resection of a rectal tumor using TEM in our institution from April 2011 to September 2013 were included.
  
  
  METHODS
  Standardized retrospective chart review was performed. Primary outcome was 30-day mortality and morbidity. Secondary outcomes included unplanned admission and readmission rates, operative and pathologic data.
  
  
  RESULTS
  Of the 175 patients who underwent only TEM, 80% (140/175) were discharged the same day of surgery. There was no mortality. Morbidity rate was 31.4%. Ninety-one percent of 154 patients planned as outpatients were discharged the same day. The most common reason for unplanned admission was urinary retention (7/14; 50%). Twelve patients discharged the day of the procedure were readmitted at 30 days. Median operative time was 60 min (10-256 min). All lesions were removed with grossly negative margins with 15 positive microscopic margins on final pathology. A total of 124 adenomatous polyps and 37 malignant lesions were excised. Mean tumor diameter after fixation was 5.0 cm (range 0.5-11 cm).
  
  
  CONCLUSIONS
  Transanal endoscopic microsurgery as an outpatient procedure is feasible and safe in selected patients. The main reason for unplanned admission was urinary retention in our series.
authors: Department of Surgery, Quebec City University Hospital Center, Laval University, Quebec City, Canada. annesophielalitalie@hotmail.com.
authors: Anne-Sophie
authors: AS
authors: Laliberte
authors: Department of Surgery, Quebec City University Hospital Center, Laval University, Quebec City, Canada.
authors: Aude
authors: A
authors: Lebrun
authors: Department of Surgery, Quebec City University Hospital Center, Laval University, Quebec City, Canada.
authors: Sebastien
authors: S
authors: Drolet
authors: Department of Surgery, Quebec City University Hospital Center, Laval University, Quebec City, Canada.
authors: Philippe
authors: P
authors: Bouchard
authors: Department of Surgery, Quebec City University Hospital Center, Laval University, Quebec City, Canada.
authors: Alexandre
authors: A
authors: Bouchard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D000067369:Transanal Endoscopic Microsurgery / Q000592:standards*
keywords: Outpatient procedure; Postoperative urinary retention; Same day surgery; Transanal endoscopic microsurgery