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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Transanal Endoscopic Microsurgery (TEMS)

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Back to work
1-7 days
Success rate
Greater than 95% (benign lesions)
Recurrence
5-15% (for T1 cancers)

What it is

What is Transanal Endoscopic Microsurgery?

Transanal Endoscopic Microsurgery (TEMS) is a specialized, minimally invasive surgical technique for the local excision of benign and early-stage malignant tumors in the rectum. It is performed through the anus using a specially designed operating proctoscope, stereoscopic 3D visualization, and specialized long instruments. The rectum is insufflated with carbon dioxide to create a stable working space, allowing for precise, full-thickness excision of rectal tumors with clear margins. TEMS provides superior access and visualization for mid and upper rectal lesions compared to standard transanal excision.

Am I a candidate?

Who is a Good Candidate for TEMS?

Ideal candidates for TEMS are patients with large benign rectal polyps (adenomas) that are not amenable to colonoscopic removal, or carefully selected patients with early-stage (T1) rectal cancers that have favorable histologic features (well-differentiated, no lymphovascular invasion) and a low risk of lymph node metastasis. It is particularly suited for lesions in the mid and upper rectum that are difficult to reach with standard transanal techniques.

Recovery

What is the Recovery Like?

Recovery after TEMS is very rapid. Most patients are discharged home the same day or after a one-night hospital stay. Pain is usually minimal and can be managed with over-the-counter pain medications. Patients can typically return to a normal diet and light activities within a few days. Strenuous activity and heavy lifting should be avoided for a couple of weeks. It is important to maintain soft stools with a high-fiber diet and adequate fluid intake during the recovery period.

Risks & considerations

What are the Risks?

While TEMS is a safe procedure, potential risks are possible. These include:

  • Bleeding: Minor bleeding from the excision site is common and usually self-limited. Significant bleeding requiring intervention is rare.
  • Perforation: There is a small risk of entering the peritoneal cavity, especially for high anterior rectal lesions. This can often be closed endoscopically but may require an abdominal operation.
  • Infection: A pelvic abscess or infection can occur, though this is uncommon.
  • Functional Changes: Some patients may experience temporary changes in bowel function, such as increased frequency, urgency, or minor incontinence. Permanent dysfunction is rare.
  • Recurrence: For malignant tumors, there is a risk of local recurrence if the cancer is more advanced than initially staged or if high-risk features are present.

Sources

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