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1. Colorectal Dis. 2011 Nov;13 Suppl 7:43-6. doi: 10.1111/j.1463-1318.2011.02781.x.
Totally transrectal endoscopic total mesorectal excision (TME).
Lacy AM, Adelsdorfer C.
Source
Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Centro Esther Koplowitz, University of Barcelona, Barcelona, Spain. al...@clinic.ub.es
Abstract
Surgical treatment has been in constant evolution in the search for minimizing incisions regardless of the complexity of the operation. Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents this progression of surgery to less invasive procedures. Transanal endoscopic microsurgery (TEM) is an ideal NOTES platform to access the peritoneal cavity endoscopically through the anus and specifically to allow colorectal resections be performed through smaller, or indeed without, abdominal incisions. Transanal rectosigmoidectomy with total mesorectal excision (TME) using TEM is a feasible and oncologically safe option. Such use of currently available combined hybrid laparoendoscopic systems provides a safe platform to define future clinical applications and advantages of NOTES. Furthermore, it stimulates the active development of technologies that will support and enable it.
© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.
PMID: 22098517 [PubMed - indexed for MEDLINE]
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2. Colorectal Dis. 2011 Nov;13 Suppl 7:32-6. doi: 10.1111/j.1463-1318.2011.02778.x.
Extending the role of Transanal Endoscopic Microsurgery (TEM) in rectal cancer.
Hompes R, Cunningham C.
Source
Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK.
Abstract
Increasingly it is becoming clear that there is a role for local excision of early rectal cancer by Transanal Endoscopic Microsurgery (TEM) as part of an organ-preservation strategy. This role is based on careful preoperative assessment, thorough postoperative histopathological examination and standardized follow up, with recourse to completion or salvage radical surgery in the face of poor prognostic factors, or early concerns over recurrent disease. Additionally, TEM is also proposed in selected circumstances after neoadjuvant treatment for rectal cancer. This latter topic is even more controversial with clinical evidence still evolving, but specialist centres report impressive results that cannot be ignored in the modern management of rectal cancer.
© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.
PMID: 22098515 [PubMed - indexed for MEDLINE]
Related citations

3. Surg Endosc. 2009 Dec;23(12):2680-3. Epub 2009 Jan 27.
Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise.
Baatrup G, Borschitz T, Cunningham C, Qvist N.
Source
Department of Surgery, Haukeland University Hospital, Jonas Liesvei, N-5021, Bergen, Norway. gunnar....@helse-bergen.no
Abstract
BACKGROUND:
This study was designed to investigate short-term and long-term consequences from perforation to the peritoneal cavity during transanal endoscopic microsurgery (TEM) for rectal cancer, with special emphasis on local recurrence and complications.
METHODS:
Data from TEM procedures with peritoneal perforations were collected from six prospective databases. Patient, procedure, and follow-up data were extracted. Participating centers were the United Kingdom TEM database, the German TEM database from Mainz, the National Danish TEM database, and databases from the three major Norwegian TEM centers. A total of 888 TEM procedures were registered, and 22 perforations were identified.
RESULTS:
Median age was 82 years. Tumor stages were 14 pT1, 4 pT2, 3 pT3, and 1 pTx. The mean tumor size was 4.1 cm. Radical resection was achieved in 17 patients. All perforations were handled endoscopically. There were no severe complications and no deaths related to the procedure. The mean time of observation was 37 (median 36; range 3-164) months. Local recurrence occurred in two patients, three patients died from the cancer (distant metastasis), and six died from other causes.
CONCLUSIONS:
Breaching the peritoneum during TEM is not associated with major short-term complications or long-term oncological consequences provided that primary endoscopic repair is undertaken.
PMID: 19172355 [PubMed - indexed for MEDLINE]
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1.	Colorectal Dis. 2011 Nov;13 Suppl 7:43-6. doi: 10.1111/j.1463-1318.2011.02781.x. Totally transrectal endoscopic total mesorectal excision (TME). Lacy AM, Adelsdorfer C. Source Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Centro Esther Koplowitz, University of Barcelona, Barcelona, Spain. al...@clinic.ub.es Abstract Surgical treatment has been in constant evolution in the search for minimizing incisions regardless of the complexity of the operation. Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents this progression of surgery to less invasive procedures. Transanal endoscopic microsurgery (TEM) is an ideal NOTES platform to access the peritoneal cavity endoscopically through the anus and specifically to allow colorectal resections be performed through smaller, or indeed without, abdominal incisions. Transanal rectosigmoidectomy with total mesorectal excision (TME) using TEM is a feasible and oncologically safe option. Such use of currently available combined hybrid laparoendoscopic systems provides a safe platform to define future clinical applications and advantages of NOTES. Furthermore, it stimulates the active development of technologies that will support and enable it. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.
	PMID: 22098517 [PubMed - indexed for MEDLINE]
	Related citations

2.	Colorectal Dis. 2011 Nov;13 Suppl 7:32-6. doi: 10.1111/j.1463-1318.2011.02778.x. Extending the role of Transanal Endoscopic Microsurgery (TEM) in rectal cancer. Hompes R, Cunningham C. Source Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK. Abstract Increasingly it is becoming clear that there is a role for local excision of early rectal cancer by Transanal Endoscopic Microsurgery (TEM) as part of an organ-preservation strategy. This role is based on careful preoperative assessment, thorough postoperative histopathological examination and standardized follow up, with recourse to completion or salvage radical surgery in the face of poor prognostic factors, or early concerns over recurrent disease. Additionally, TEM is also proposed in selected circumstances after neoadjuvant treatment for rectal cancer. This latter topic is even more controversial with clinical evidence still evolving, but specialist centres report impressive results that cannot be ignored in the modern management of rectal cancer. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.
	PMID: 22098515 [PubMed - indexed for MEDLINE]
	Related citations

3.	Surg Endosc. 2009 Dec;23(12):2680-3. Epub 2009 Jan 27. Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise. Baatrup G, Borschitz T, Cunningham C, Qvist N. Source Department of Surgery, Haukeland University Hospital, Jonas Liesvei, N-5021, Bergen, Norway. gunnar....@helse-bergen.no Abstract BACKGROUND: This study was designed to investigate short-term and long-term consequences from perforation to the peritoneal cavity during transanal endoscopic microsurgery (TEM) for rectal cancer, with special emphasis on local recurrence and complications. METHODS: Data from TEM procedures with peritoneal perforations were collected from six prospective databases. Patient, procedure, and follow-up data were extracted. Participating centers were the United Kingdom TEM database, the German TEM database from Mainz, the National Danish TEM database, and databases from the three major Norwegian TEM centers. A total of 888 TEM procedures were registered, and 22 perforations were identified. RESULTS: Median age was 82 years. Tumor stages were 14 pT1, 4 pT2, 3 pT3, and 1 pTx. The mean tumor size was 4.1 cm. Radical resection was achieved in 17 patients. All perforations were handled endoscopically. There were no severe complications and no deaths related to the procedure. The mean time of observation was 37 (median 36; range 3-164) months. Local recurrence occurred in two patients, three patients died from the cancer (distant metastasis), and six died from other causes. CONCLUSIONS: Breaching the peritoneum during TEM is not associated with major short-term complications or long-term oncological consequences provided that primary endoscopic repair is undertaken.
	PMID: 19172355 [PubMed - indexed for MEDLINE]
	Related citations