Transanal Endoscopic Microsurgery (TEMS) is a minimally invasive surgical technique designed for the precise removal of rectal tumors. Developed in the 1980s, TEMS provides a safe and effective alternative to more invasive procedures, such as low anterior resection or abdominoperineal resection, particularly for benign and early-stage malignant lesions in the rectum.

Indications:
TEMS is primarily indicated for:

Benign rectal polyps that are not amenable to endoscopic removal.

Early-stage rectal cancers (T1) confined to the mucosa or submucosa without lymph node involvement.

Selected cases of local recurrence after previous surgery.

Advantages:
TEMS offers several benefits over traditional surgical approaches:

Minimally invasive: No abdominal incision is required.

Organ preservation: The anal sphincter and rectum are preserved, maintaining bowel function.

Reduced morbidity: Lower risk of complications like infection, bleeding, and postoperative pain.

Shorter recovery: Patients often return home within 24–48 hours.

Enhanced precision: High-definition endoscopic visualization allows accurate excision of tumors with clear margins.

Procedure:

Preparation: Patients undergo bowel cleansing and are given either general or regional anesthesia.

Access: A specialized rectoscope is inserted through the anus, providing a stable platform and magnified view of the rectal lesion.

Excision: Using specialized instruments, the surgeon carefully excises the lesion with precise margins.

Closure: The surgical site may be left open to heal or sutured depending on the defect size and location.

Postoperative Care:

Patients are monitored for immediate complications such as bleeding or perforation.

A liquid or soft diet is recommended initially.

Follow-up colonoscopy or imaging is performed to monitor for recurrence.

Limitations:

TEMS is technically demanding and requires specialized training and equipment.

Lesions located too high in the rectum or with deep invasion may not be suitable.

Not ideal for advanced-stage cancers where lymph node dissection is required.

Outcomes:
Clinical studies demonstrate that TEMS provides excellent local control for early rectal tumors with minimal impact on quality of life. Recurrence rates are low when careful patient selection is followed.

Conclusion:
Transanal Endoscopic Microsurgery represents a modern, organ-preserving approach to rectal surgery. It is especially valuable for patients with benign polyps or early-stage rectal cancers, offering a combination of precision, safety, and faster recovery. With increasing expertise and technological advancements, TEMS continues to gain recognition as a standard minimally invasive technique for rectal lesions.