Peking Union Medical College Hospital was the first in China to introduce transanal endoscopic microsurgery (TEM), a cutting-edge technique for treating rectal tumors. This procedure involves inserting a 4 cm-wide proctoscope through the anus into the rectum, allowing surgeons to access the area via four channels on the device. Equipped with stereoscopic mirrors and specialized instruments, doctors perform precise tumor removal under a high-magnification microscope. Developed by German experts in 1983, TEM has been widely used in Europe and Japan as a standard treatment for early-stage rectal cancers and benign conditions.
In traditional surgery, rectal tumors close to the anus are often treated with transanal resection, which can be challenging due to limited visibility and difficulty in achieving complete removal. For tumors located further up, laparotomy is typically required, which is more invasive and carries higher risks of complications. While some hospitals have adopted less invasive methods like the transanal sphincter approach, they still involve significant trauma.
TEM offers several advantages over conventional techniques. First, it is minimally invasive, leaving no skin incisions and reducing scarring. It also allows patients who would otherwise require an abdominoperineal resection to retain their anal function. Second, the procedure can remove tumors from any distance along the rectum, thanks to the clear visualization provided by the microscope, ensuring accurate and complete excision. Third, the operation usually takes only about an hour, with minimal blood loss—often just 5–10 ml—and no need for blood transfusions. Fourth, the risk of complications is significantly lower due to the precision of the technique and reduced tissue damage. Fifth, high-quality tissue samples can be obtained during the procedure, enabling accurate pathological evaluation. Lastly, patients recover faster, with shorter hospital stays and quicker return to normal activities.
Since April this year, the hospital has successfully performed eight TEM procedures, with all patients recovering well and experiencing no postoperative complications. One such case involved Mr. Zhang, a 70-year-old patient who initially presented with rectal bleeding. After being diagnosed with a rectal villous adenoma, he underwent a snare polypectomy. However, the condition recurred, and a second examination revealed a 2×2.5 cm early rectal cancer lesion. Traditionally, this would have required open abdominal surgery, but the hospital opted for TEM instead. The surgery, led by Dr. Qiu Huizhong, took just one hour, and the patient was walking within three days and discharged after seven days.
TEM requires highly skilled surgeons who are trained in both traditional rectal surgery and the specific techniques of this advanced method. Because the procedure is performed on a flat plane, unlike laparoscopic surgery, it relies heavily on visual guidance through a TV screen or stereoscopic lenses. Post-operative suturing in a confined space also demands experience and precision. The technology is particularly suitable for rectal adenomas, early rectal cancers, palliative treatments for advanced cases, and other benign conditions like rectal stenosis or mucosal prolapse.
This innovative approach marks a significant advancement in colorectal surgery, offering patients a safer, more effective, and less invasive alternative to traditional methods.
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