Transanal Endoscopic Microsurgery (TEM):

Transanal Endoscopic Microsurgery (TEM) is a minimally invasive technique developed in the 1980s for the precise removal of rectal tumours and polyps. It employs a sophisticated three-dimensional viewing system and a rectoscope, along with the creation of a pneumonectomy, to provide comprehensive access to the entire rectum. Using specialised instruments and a high-definition endoscope inserted through the anus, TEM eliminates the need for external incisions. 

This advanced approach allows surgeons to excise abnormal growths with exceptional accuracy by leveraging the magnified view for precise and effective treatment. However, despite its advanced capabilities, TEM is not widely used due to its high cost, steep learning curve, and the complexity of the necessary equipment. Over time, Transanal Endoscopic Operation (TEO) has emerged from TEM as a newer, potentially more accessible technique that builds on the principles of TEM while addressing some of its limitations.

Transanal Minimally Invasive Surgery (TAMIS):

Transanal Minimally Invasive Surgery (TAMIS  is another advanced minimally invasive surgery for rectal issues. It differs from TEM in that it uses a flexible, gel-like port inserted through the anus, rather than a rigid tube. This port allows the surgeon to insert a camera and laparoscopic tools (the same ones used in other minimally invasive surgeries). 

The main difference between TEM  and TAMIS is the equipment used. TAMIS uses more common laparoscopic tools, which makes it easier for surgeons who are already skilled in laparoscopic techniques. Moreover, TAMIS generally takes less time to set up and perform.

TEM and TAMIS are both efficient at removing problematic tissues in the rectum. Here are among the conditions that can be treated by using these minimally invasive procedures:

• Benign rectal lesions: these non-cancerous tumours are removed by inserting small surgical tools through the anus. The surgeon carefully excises the lesions along with a bit of surrounding healthy tissue to ensure it's all gone and to prevent it from coming back. 
• Early-stage rectal cancer: for early-stage cancers confined to the rectum, the surgeon uses TEM or TAMIS to completely remove the cancerous tissue and some surrounding healthy tissue to ensure clean margins. 
• Rectal polyps: Polyps that could become cancerous or are already localised cancers are removed using the same minimally invasive approach. The surgeon inserts a camera and tools through the anus to excise the polyps, which helps in preventing the progression to more serious cancer and allows for early intervention with minimal discomfort.
• Rectal fistulas: for abnormal connections between the rectum and other organs, such as the bladder or vagina, TEM provides a clear view and access to the affected area. The surgeon can then repair the fistula specifically, minimising the need for larger, more invasive procedures and promoting faster healing.
• Rectal strictures: when there’s a narrowing of the rectum at a previous surgical connection site, TEM is used to widen the narrowed section. This alleviates symptoms like bowel obstruction.
• Rectal prolapse: for rectal prolapse, where the rectum protrudes through the anus, TEM can fix the rectum back into place. The surgeon attaches the posterior wall of the rectum to the presacral tissue, restoring normal anatomy and function.
• Advanced rectal cancer (palliative treatment): for patients who can’t undergo radical surgery due to high risk or personal preference, TAMIS can be used to alleviate symptoms. The surgeon removes as much of the tumour as possible to reduce pain and other symptoms.
• Gastrointestinal stromal tumours (GIST): these tumours are removed from the rectum using TEM. The surgeon gets rid of the tumour, ensuring clear margins to prevent recurrence while preserving as much normal tissue as possible.

From the moment you enter our clinic for Transanal Endoscopic Microsurgery (TEM), Transanal Endoscopic Operation (TEO), or Transanal Minimally Invasive Surgery (TAMIS), you can expect a comprehensive and patient-centered approach to your care. Upon arrival, you will be prepared for the procedure with detailed instructions and any necessary preoperative assessments.

During the procedure, the minimally invasive techniques of TEM, TEO, and TAMIS ensure high precision and accuracy in removing rectal tumours or polyps. The use of advanced endoscopic equipment allows for clear, magnified visualisation of the surgical area, which results in effective and efficient excision of abnormal tissues. The procedures are performed through the anus, eliminating the need for external incisions and thus minimising trauma to surrounding tissues.

After the surgery, you will be closely monitored in our recovery area. Patients typically experience minimal postoperative pain due to the lack of external incisions. The risk of complications, such as infections and excessive bleeding, is significantly reduced. You can expect a shorter hospital stay, often being discharged the same day or within 24 hours, depending on the complexity of the procedure and your individual recovery progress.

In the weeks following the procedure, you will have follow-up appointments to ensure proper healing and address any concerns. Most patients are able to return to their normal activities much sooner than with traditional open surgeries.