Full thickness excision of T1 rectal cancer with transanal endoscopic microsurgery

Background: Transanal endoscopic microsurgery is a useful method for the local excision of polyps and selected rectal cancers. The standardization of the technique for this procedure is likely to be important for preventing local recurrence. This video demonstrates the standard procedure of TEM in a patient with a 5cm rectal polyp. Methods: The patient was placed in the left lateral decubitus position to put the tumor at 6 o’clock, as the tumor was on the left side of the rectum. Carbon dioxide insufflation at 12 mmHg was used after insertion of the rectoscope. A 1cm margin around the lesion was marked and the Harmonic scissor was used to make a full thickness excision including perirectal fat. Primary closure of the defect was performed with 3/0 absorbable suture and intraluminal suturing. Results: The tumor was located 6cm from the anal verge. Operation time was 90 minutes and blood loss was 50 ml. Pathology showed invasive moderately differentiated adenocarcinoma arising in a tubulovillous adenoma with high grade dysplasia. There was one perirectal lymph node with no evidence of metastasis. The closest margin was 0.7cm from the cancer. The patient was discharged on POD 1 day without complications. Conclusions: This video demonstrates full thickness excision of a T1 rectal cancer using a TEM technique, and highlights the closure of a large defect with intraluminal suturing.

Session: Podium Presentation

Program Number: V013

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