TEM-Yöntemi

TEM Method

What is the TEM Method (Transanal Endoscopic Microsurgery)?

Early-stage tumors in the rectum region near the anus that have not spread to the anal sphincter can be treated with the TEM method. This method, defined as transanal excision surgery, is based on the discipline of removing tumors by entering through the anus. The fact that no incision is required in the abdominal region is one of the factors that play an important role in the preference of TEM method.

TEM can also be used to remove rectal polyps that are too large to be removed by colonoscopy. It is also used to remove polyps located too high up to be accessible.

In treatment with the TEM method under general anesthesia, the rectum is inflated with carbon dioxide. This provides the necessary space for endoscopy and surgical equipment. The duration of this surgical procedure varies between 30 minutes and three hours. After the operation, the patient is given painkillers to control the pain. Consumption of liquid and solid foods can be started immediately. The duration of hospitalization is 1 to 2 days.

What are the Advantages of the Tem Method?

The number of surgeons who can perform the TEM method, which is not a common practice today, is also very few. The TEM method, which is usually performed in large cancer centers, provides great advantages for both the surgeon and the patient. In the conventional treatment of rectal cancer, the mesorectum and lymph nodes are removed by inferior anterior resection or abdominoperineal resection. However, in the TEM method, the lymph nodes are not removed. In this case, the staging process of cancer cannot be carried out comprehensively.

Surgeons who will apply the TEM method should choose the appropriate patient very carefully. Patients should not be disappointed when they learn that this treatment method will not be suitable. Because after a detailed diagnosis and evaluation, the surgeon has decided that the location and stage of the tumor is not suitable for the TEM method.

TEM is not the best way to remove the cancerous cell, prevent recurrence or increase the chances of survival. Whether or not the patient is a suitable candidate for these minimally invasive techniques, it may be necessary to seek the opinion of a second surgeon for evaluation.

History of the Tem Method

Today, the TEM method is successfully performed in suitable patients. Developed in the 1980s, this method provides a much faster healing and comfortable treatment process.

The history of the TEM method is as follows;

  • 1980: Beginning of technological development at the University of Cologne
  • 1981-1983: Experimental development and applications
  • 1983-1985: Clinical practice in Cologne
  • 1985-1989: Clinical practice in Mainz
  • 1989-1997: Clinical practice in malignant tumors in Tuebingen
  • 1998-2005: Clinical practice in Munich and Muellheim
  • 2008: Use in NOTES technology (transvaginal cholecystectomy and transrectal colectomy)

Indications of the Tem Method

Situations where TEM method can be applied can be listed as follows;

  • Rectal ulcer
  • Ensuring control of bleeding in the rectum area
  • Rectal tumors and sigmoid tumors
  • Treatment of polyps, adenomas, carcinoids and lesions in the rectum
  • Highly localized fistulas
  • Strictures

What is Rectal Cancer?

The part of the large intestine that opens into the rectal canal is defined as the rectum. Cancers that occur in this area are also called rectal cancer. The organ located in the area in front of the coccyx, which is the last part of the large intestine, is called the rectum. Rectum sections are divided into upper, middle and lower rectum. 

  • Lower rectum; It is the part 4 - 5 cm above the entrance of the anus.
  • Middle rectum; It is between 6 - 10 cm from the entrance of the anus.
  • Upper rectum is 10 cm above the anus entrance.

Stages of Rectal Cancer

Rectal cancer consists of four different stages and staging before rectal cancer treatment is of great importance for the success of the treatment. It is also important to consider whether cancerous cells have spread to any other organs. The stages of rectal cancer are as follows;

  • Stage 0; Cancer is found only in the lining covering the inner wall of the intestine. It is also known as the initial stage. It is not possible for cancer at this stage to spread through blood and lymph routes. 
  • Stage 1; It is cancer that has formed in the intestinal wall. It is limited to the area where it is formed and has not spread to the lymph nodes.
  • Stage 2; It is the stage where the cancer has spread to the entire intestine and spread to neighboring organs. 
  • Stage 3; Rectal cancer has spread to the lymph nodes and lymph nodes. 
  • Stage 4; Cancerous cells have also spread to distant organs.

Symptoms of Rectal Cancer

Symptoms of rectal cancer are as follows;

  • Constipation
  • Blood coming from the anus
  • Difficulty defecating
  • Blood in the stool
  • Reduced stool diameter
  • Abdominal pain
  • Loss of appetite
  • Pain in the hip bone

Rectal Cancer Treatment

Surgical methods and supportive radiotherapy can be used in the treatment of rectal cancer. Both drug treatment and surgical methods together with radiotherapy are planned after a detailed diagnosis and staging process. Endoscopic stenting is performed if cancerous cells block the rectal canal. With this procedure, the rectal canal is opened and defecation becomes possible. 

After the endoscopic stenting procedure, surgery is performed with robotic or laparoscopic surgery methods depending on the patient's condition and the surgeon's decision.

Rectal Cancer Surgery

The main methods used in rectal cancer surgery are as follows;

  • Colo-anal anastomosis 
  • Local or transanal excision
  • Lower anterior resection
  • Miles surgery
  • TEM method

TEM Application in Rectal Cancer

It is applied with a method similar to laparoscopic surgery discipline. The rectum area is inflated with a rectoscope placed in the rectum and the applications are then performed. TEM method provides advantages to the patient and the doctor in terms of healing process and comfort. However, it also has disadvantages in terms of the length of the learning process and being a very costly treatment method.

Interventional Surgery for Rectal Tumors

The diagnosis and treatment of rectal tumors has been practiced for many years. This process is far from comfortable for both the patient and the doctor, but it is a long process. Today, the treatment of tumors detected in the rectum area with interventional methods takes much less time and facilitates the patient's recovery process.

Diagnosis of rectal cancer in the patient requires an open surgical procedure. The doctor who will perform the surgery has to make a deep incision. Thus, he will reach the tumor, evaluate whether cancerous cells have spread and assess the health status of neighboring tissues.

This process, which is quite challenging, is nowadays tried to be made more comfortable with different interventional interventions. These methods include laparoscopic resection and transanal endoscopic microsurgery (TEM).

Interventional Pathway in Rectal Tumors

Minimally interventional surgeries, which were first applied in the 1980s, are defined as new applications. These methods have great advantages over open surgery. The most important of these advantages are less pain and soreness and shorter recovery time. The fact that small holes are made in interventional treatment methods instead of the large incisions made in open surgeries is also effective in preventing risks such as infection or bleeding. Interventional treatment methods are performed with the help of superior technological imaging tools. The surgeon is thus able to see the area he/she is working on in detail.