Colon Surgery Without a Single Cut: TEMS

Removes large rectal polyps, early-stage rectal cancer

Colon Surgery Without a Single Cut: TEMS

What surgery is done without any incisions? People hear “surgery” and they think “scalpel” or “scar.”

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But today, there are surgeries that can be performed without one cut, such as transanal endoscopic microsurgery, or TEMS.

This procedure is performed entirely through the anus and rectum and offers an effective, quick-recovery treatment to completely remove large rectal polyps and early-stage rectal cancer.

Even though we’re limited in the use of this procedure to a select group of patients with specific diseases, I think it has important implications for the future of minimally invasive colorectal surgery.

How patients benefit from TEMS

Because no incision is necessary, TEMS is an excellent alternative to major abdominal surgery with a much quicker recovery time.

The procedure is virtually painless and requires only an overnight stay at the hospital. It’s an important option for the elderly or others who can’t tolerate major abdominal surgery.

Other important advantages to TEMS surgery:

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  • Less bleeding
  • Reduced risk of infection and complications
  • Less risk of bowel obstructions post-surgery

Who can have TEMS?

During your colonoscopy, if large polyps or early stage rectal tumors are found in your rectum that can’t be removed by the colonoscope, you’ll be referred to a rectal surgeon.

If you’re an appropriate candidate, TEMS may be an option. Talk to your surgeon to find out for sure.

What happens during TEMS

Before the TEMS procedure, you undergo a full bowel preparation – just like a colonoscopy.

What happens during the surgery:

  1. Patients receive a general anesthetic.
  2. Before the surgery a proctoscope — a tube fitted with the two long, skinny TEMS microsurgical instruments and a camera — is inserted into the anus and rectum. It is positioned over the lesion to be removed.
  3. The rectum is filled with gas so the surgeon has room to see and remove the rectal polyps and early stage cancer.
  4. Using the instruments the surgeon grabs the lesion, cuts it out, and sutures the area.

TEMS: challenges and the future

TEMS isn’t as widely used as laparoscopic surgery or robotics in treating colorectal cancers because:

  • The procedure is difficult to perform. The instruments are not “wristed” — where they can perform a range of motions, like a human wrist — as they are in robotic surgery.
  • The number of patients is limited. Because the instruments and scope are straight and the patient’s backbone gets in the way, we can only reach polyps or cancers in the rectum. The scope is not able to turn like a normal colonoscope, so we can’t access 90 percent of the bowel as we can with a colonoscopy. And this procedure does not get all of the lymph nodes in the area — so it’s not good for more advanced cancers, where the goal is to remove all of the lymph nodes along with the cancer.

But TEMS is the epitome of non-invasive surgery. One of our goals as colorectal surgeons is minimizing the incisions made during surgery.

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Today, we’re able to take out the colon through the belly button, but an incision is still necessary. It’s exciting to consider that as technology advances, if we’re able to get “wristed” instruments through the TEMS device, we will be able to perform major surgery through just one hole inside the body. We’ll be able to transect the rectum and remove the colon, entirely through the anus.

All without making a cut on the outside of the body.

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Treatment guide and fact sheets                                                                                         

Free Colonoscopy Fact Sheet
Free Colon and Rectal Cancer Treatment Guide

More information 

Take Cleveland Clinic’s Free Online Colon Cancer Risk Assessment
Free Colonoscopy Fact Sheet
Free Colon and Rectal Cancer Treatment Guide
Treatments and Procedures: Rectal Cancer
Hereditary Colon Cancer
Colon Cancer Overview
Risk Factors for Colon Cancer
How to Prevent Colon Cancer

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Meagan Costedio, MD

Meagan Costedio, MD, is a surgeon in the Department of Colorectal Surgery whose interests include minimally invasive techniques.
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