Transanal Endoscopic Microsurgery (TEM) and Endoscopic Mucosal Resection (EMR)

Advanced techniques allow experienced surgeon’s to remove tumors from the colon or rectum without a major abdominal operation, and in some cases entirely without incisions.

Transanal Endoscopic Microsurgery (TEM)

Transanal endoscopic microsurgery is a minimally invasive surgical technique that provides your surgeon with access to issues within the mid to upper rectum, without requiring an abdominal incision as is necessary in traditional rectal tumor excisions. The operation is performed by trained and experienced surgeons, using specially designed equipment inserted into the rectum.

The day prior to the procedure, you will be asked to perform a bowel cleansing with medicine similar to that used for a colonoscopy. You will also be asked not to eat or drink anything after midnight prior to the operation. The operation is performed in a hospital under anesthesia.

During the course of a TEM, the rectum is filled with carbon dioxide to hold open the normally closed rectum and to allow your surgeon to better visualize and operate upon the lesion to be resected. The affected area of the rectum is viewed with a specially designed magnifying lens and a video camera. Your surgeon is able to view, hold, cut and suture the rectum and tumor using long instruments, without any external incisions on the abdominal wall.

If successful, patients are able to undergo removal of rectal tumors with major abdominal surgery. As with any operation, there are potential risks, and these should be discussed with your surgeon.

Endoscopic Mucosal Resection (EMR)

Endoscopic mucosal resection (EMR) is an endoscopic procedure designed to remove certain tumors from parts of the colon which could only be reached through a traditional abdominal operation. If successful, patients are able to avoid an abdominal incision and a major operation.

The day prior to the procedure, you will be asked to perform a bowel cleansing with medicine similar to that used for a colonoscopy. You will also be asked not to eat or drink anything after midnight prior to the operation. The operation is performed in a hospital under anesthesia. EMR does not require an external incision, which yields the added benefit of minimal post-operative pain and a faster recovery time compared with traditional operations. Many patients are able to return home just hours after their procedure is completed.

The procedure is performed using a colonoscope, which is a long, flexible tube and camera which is inserted into the rectum and visually guided through the colon, to the tumor. At the tip of the colonoscope is a tubular fitting which enables the surgeon to perform the resection. Once at the location of the tumor, various techniques are used to mark and then elevate the tumor. At this point, the tumor is removed, retrieved and sent to a pathologist for microscopic evaluation. If the tumor is benign (not malignant), no further treatment other than regularly scheduled colonoscopic evaluation is necessary. If the tumor is malignant (a cancer), a more extensive abdominal operation is usually necessary. Very rarely, if the resected tumor is in the most early stages of disease, no further operation is necessary. However, this is a rare situation.

EMR also carries risks, the most serious being an immediate or delayed perforation at the site of the resection. Your surgeon will discuss these risks with you prior to performing the procedure.

Surgical skill, training and experience are required to perform EMR.