Transanal Endoscopic Microsurgery in Small, Large, and Giant Rectal Adenomas

Abstract

Transanal endoscopic microsurgery (TEMS) is a minimally invasive technique for local excision of some rectal adenomas and other lesions not amenable to traditional endoscopic resection. It was first described by Buess et al¹ in 1984 and since then has gained popularity in view of its safety and ability to provide intact full-thickness specimens with low R1 resection and recurrence rates.^2-5 However, there is some debate as to the best technique for excision of large (>3 cm), and particularly giant, rectal adenomas in view of the increased risk for occult malignancy in large adenomas^5-9 combined with the significant incidence of R1 resections for traditional peranal techniques and piecemeal resection for endoscopic techniques such as endoscopic mucosal resection (EMR) in these lesions.^7,10-13