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TEMS (Transanal Endoscopic Micro-Surgery) of the rectum is a minimally
invasive surgical technique which has been developed to treat benign tumours
of the rectum (adenomas) and rectal cancer.
TEMS was developed in Germany in the 1980s but it took a long time to spread
to the rest of the world and the UK for three reasons; it is a technically
challenging operation which requires specific training, it uses expensive
equipment and the indications for selection of appropriate patients were not
from the beginning clear.
TEMS is now a recognised procedure which is practised in a few centres in the
UK and King's College Hospital is one of them.
Indications for TEMS
Before the development of TEMS the only solution for complete removal of large
rectal tumours which were 5 cms or more from the anal margin was to submit the
patient to anterior resection of the rectum. This major operation is unnecessary
for benign tumours such as adenomas. TEMS is now the ideal treatment of
choice for large adenomas of the rectum.
Also, early cancers (stage T1) can be excised with TEMS with the same survival
as with anterior resection but with less risk of complications and peri-operative
death. TEMS is preferred for such early cancers if the patient is elderly (more
than 80+) or unfit ( ASA IV,multiple medical problems) because in those cases
major surgery has high risk of death.
In cases of cancer TEMS is combined with radiotherapy and chemotherapy.
Studies from Germany, Liverpool etc. showed that in elderly or unfit patients this
treatment can have the same results as radical surgery with fewer surgical
complications.
If a cancer of the rectum has already spread to other parts of the body then
there is no point of doing radical surgery of the rectum. The main effort in those
cases concentrates on chemotherapy. However the rectal cancer may cause
symptoms which affect the patient’s quality of life, such as obstruction, pain,
bleeding, tenesmus etc. TEMS is an excellent palliative operation which can
relieve the patient from those symptoms and improve quality of life.
Technique of TEMS
The patient has full bowel preparation as for bowel resection.
An operating sigmoidoscope with a diameter of 40 mm is inserted into the anus.
The rectum is insufflated and a camera and specially designed instruments are
inserted. Excision of the tumour and the full thickness of the rectal wall) is
performed in the same way as with laparoscopic surgery). The rectal defect may
or may not be closed, depending on the size and the judgement of the surgeon.
The patient can mobilise, eat and drink immediately and usually requires only
one night’s stay in hospital. Antibiotics are given orally for a week to prevent the
risk of abscess.
For a more extensive description of the technique and indications of
TEMS click on the link here:
©COPYRIGHT OF www.bowel-health.com contents by Dr. Savvas
Papagrigoriadis. All rights reserved.
invasive surgical technique which has been developed to treat benign tumours
of the rectum (adenomas) and rectal cancer.
TEMS was developed in Germany in the 1980s but it took a long time to spread
to the rest of the world and the UK for three reasons; it is a technically
challenging operation which requires specific training, it uses expensive
equipment and the indications for selection of appropriate patients were not
from the beginning clear.
TEMS is now a recognised procedure which is practised in a few centres in the
UK and King's College Hospital is one of them.
Indications for TEMS
- Benign tumours of the rectum (adenomas etc.)
- Early cancer of the rectum
- Palliative treatment of cancer of the rectum
Before the development of TEMS the only solution for complete removal of large
rectal tumours which were 5 cms or more from the anal margin was to submit the
patient to anterior resection of the rectum. This major operation is unnecessary
for benign tumours such as adenomas. TEMS is now the ideal treatment of
choice for large adenomas of the rectum.
Also, early cancers (stage T1) can be excised with TEMS with the same survival
as with anterior resection but with less risk of complications and peri-operative
death. TEMS is preferred for such early cancers if the patient is elderly (more
than 80+) or unfit ( ASA IV,multiple medical problems) because in those cases
major surgery has high risk of death.
In cases of cancer TEMS is combined with radiotherapy and chemotherapy.
Studies from Germany, Liverpool etc. showed that in elderly or unfit patients this
treatment can have the same results as radical surgery with fewer surgical
complications.
If a cancer of the rectum has already spread to other parts of the body then
there is no point of doing radical surgery of the rectum. The main effort in those
cases concentrates on chemotherapy. However the rectal cancer may cause
symptoms which affect the patient’s quality of life, such as obstruction, pain,
bleeding, tenesmus etc. TEMS is an excellent palliative operation which can
relieve the patient from those symptoms and improve quality of life.
Technique of TEMS
The patient has full bowel preparation as for bowel resection.
An operating sigmoidoscope with a diameter of 40 mm is inserted into the anus.
The rectum is insufflated and a camera and specially designed instruments are
inserted. Excision of the tumour and the full thickness of the rectal wall) is
performed in the same way as with laparoscopic surgery). The rectal defect may
or may not be closed, depending on the size and the judgement of the surgeon.
The patient can mobilise, eat and drink immediately and usually requires only
one night’s stay in hospital. Antibiotics are given orally for a week to prevent the
risk of abscess.
For a more extensive description of the technique and indications of
TEMS click on the link here:
©COPYRIGHT OF www.bowel-health.com contents by Dr. Savvas
Papagrigoriadis. All rights reserved.
Flat carpet-like
adenoma of the
rectum. This can be
excised by TEMS but
not with the
colonoscope.
adenoma of the
rectum. This can be
excised by TEMS but
not with the
colonoscope.
Extensive carpet-like
adenoma of the
rectum. TEMS can
excise this lesion
although its size
creates the risk of
stricture.
adenoma of the
rectum. TEMS can
excise this lesion
although its size
creates the risk of
stricture.
TEMS (Transanal Endoscopic Micro-Surgery)