Video-Assisted Transanal Endoscopic Microsurgery of Rectal Tumours - V-TEM

Background: Transanal endoscopic microsurgery (TEM) has become increasingly established as the method of choice for the local resection of endoscopically unresectable rectal adenomas and early-stage, low-risk rectal carcinomas. Multiple studies have shown that the single port-technique TEM results in significantly less trauma with comparable overall treatment outcome as compared to conventional radical surgical techniques. However, TEM is not widely used due to high initial set-up costs, the need for highly complex equipment and demanding surgical skill requirements. Patients and Methods: To mitigate these challenges we have successfully developed a video-assisted TEM (V-TEM) method, which resulted in approximately 50% lower initial set-up costs through the introduction of simplified original TEM surgical equipment. Between October 2003 and September 2011 we have completed 103 resections using the V-TEM method. Results: The observed rates of complications and local recurrences are comparable to reported rates. Conclusions: We were able to mitigate the challenges of TEM through the establishment of the technically less demanding V-TEM method, which resulted in approximately 50% lower initial set-up costs while maintaining overall treatment outcomes.