Transanal Approaches: Transanal Endoscopic Surgery

To a large degree, the development of transanal endoscopic microsurgery (TEM) was catalyzed by the revolution started by the widespread adoption of minimally invasive surgery and laparoscopic cholecystectomy. TEM was developed by Professor Gerhard Buess in Tubingen, Germany, as a response to limitations in the ability of transanal surgery to manage proximal rectal lesions. Professor Buess developed a tool which provided substantial advantages to standard transanal excision. In 1983, following successful animal trials, Buess published a report using his innovative proctoscope to remove a rectal adenoma. The use of this technique subsequently expanded in the USA. The technology has evolved, now with the original design being augmented with a laparoscopic attachment for overhead viewing. In addition, several other innovative platforms for transanal endoscopic surgery (TES) have been developed. This chapter will serve to outline the technique, indications, outcomes, and pitfalls of the various TES techniques for the management of rectal surgery. Finally, we will discuss some newer innovative and thought-provoking uses of the TES platform.