Technique and results of transanal endoscopic microsurgery in early rectal cancer

Am J Surg. 1992 Jan;163(1):63-9; discussion 69-70. doi: 10.1016/0002-9610(92)90254-o.


The anatomy of the pelvis makes it difficult to perform local excisions in the rectum when the tumor is some distance from the anal verge. We have, therefore, developed a new minimally invasive technique for tumor resection. A rectoscope with a 40-mm diameter permits tumor resection under stereoscopic control in the gas-dilated rectal cavity. Excisions in full-thickness technique up to segmental resections with end-to-end anastomosis can be performed. In selected cases, local excision of a small rectal cancer can be regarded as appropriate treatment. However, most local resections of carcinomas are performed when removal of an adenoma is planned, and the postoperative histology shows a carcinoma. Since 1983, we have operated on 326 patients, 274 who have been enrolled in a prospective clinical trial. Definitive histologic examination proved that 74 of these tumors were carcinomas. The rate of severe complications in patients with carcinomas was 9%, and the mortality rate was 0%. The advantages of this new technique are: The stereoscopic magnified view in the gas-dilated rectum allows precise surgery in an operative field that is otherwise difficult to reach. During the postoperative period, minimal discomfort and pain result in a short hospitalization.

Publication types

  • Clinical Trial

MeSH terms

  • Adenoma / epidemiology
  • Adenoma / surgery*
  • Carcinoma / epidemiology
  • Carcinoma / surgery*
  • Endoscopes, Gastrointestinal*
  • Evaluation Studies as Topic
  • Humans
  • Microsurgery / methods*
  • Prospective Studies
  • Rectal Neoplasms / epidemiology
  • Rectal Neoplasms / surgery*
  • Rectum / surgery*