What is transanal endoscopic microsurgery (TEM)?

Written by: Mr Talvinder Gill
Published: | Updated: 13/04/2023
Edited by: Lauren Dempsey

In our latest interview, esteemed colorectal surgeon Mr Talvinder Gill explains what transanal endoscopic microsurgery is and when it is suitable. The Stockton-on-Tees-based surgeon details the benefits of this type of surgery, the possible side effects, and how long it takes to recover


What is transanal endoscopic microsurgery? 

Transanal endoscopic microsurgery (TEM) is an endoscopic operation that is performed through the anal canal.  The patient is put under anaesthesia and a large scope is inserted into the back passage to allow the doctor to have a look. Under a magnified view, small instruments are used to perform the surgery, hence why it’s called microsurgery. It is mainly used to remove large polyps, particularly reoccurring polyps that have been removed endoscopically but have returned, or small cancerous tumours that are in the lower part of the bowel. Once the polyps or tumour has been removed, the bowel walls are stitched up.

It has been proven successful as surgery for the removal of benign tumours and reoccurring polyps, and it is starting to be used as a treatment for early cancers as well. In my hospital, I’ve carried out more than 100 procedures to remove early-stage cancerous tumours through the anal canal. When compared to traditional operations, that are “bigger” and can have more side effects and complications, TEM is quite a small operation, yet its success rate in the treatment of cancer in selected patients is as good as radical surgery. The most important factor is the selection of the right patient, ensuring they don’t have any prognostic criteria which could make them an unsuitable candidate. In the case of benign tumours or polyps, it is the most effective way to remove them. 


When is transanal endoscopic microsurgery needed?

TEM is surgery that can be used for the removal of benign polyps, large polyps, reoccurring polyps, and early-stage cancer in the rectum. It is a highly-specialised procedure that is usually carried out in a tertiary referral centre by a colorectal surgeon. If an expert is able to perform TEM when treating large polyps in the rectum, it averts the need for radical surgery, which is a large surgery on the rectum often resulting in a temporary or permanent stoma. A TEM is always a better option, as nothing outside of the rectum is interfered with

Reoccurring polyps that are difficult to be managed endoscopically, can be treated by the colorectal team, with TEM. TEM can only be used as a curative for cancer in the very early stages of tumour


What are the side effects?

As the procedure is done under general anaesthetic, some of its side effects like a sore throat can be experienced by the patient until it wears off after a few hours. 
People might experience bleeding afterwards, which is a risk associated with any operation or any procedure that removes a polyp. The risk of infection is small, but if it does occur it can result in bowel irregularity. For a few weeks, until it heals, the patient can have loose stools, mucus, and bleeding from the anus. It’s not common but if a large tumour is removed it can happen. 
Initially, people feared that there would be a long-term effect on continence, due to the stretching of the anus by the insertion of a large scope. Follow up studies have shown no long-term effects on continence after TEM.
When compared to radical surgery, there are fewer side effects and complications. Radical surgery can result in a temporary or permanent stoma. In comparison, TEM is all done through the back passage and only has minor side effects. 


How long does it take to recover from transanal endoscopic microsurgery? 

Generally, TEM is a day surgery but the recovery time really depends on the extent of the surgery. Most patients go home on the same day or stay overnight. If the polyp being treated is smaller and benign, then the patient will recover quickly, in about two days. If it’s a bigger tumour, they might require four or five days to fully recover. 


If you're interested in booking a consultation with Mr Talvinder Gill, you can do so directly by visiting his Top Doctors profile.

Mr Talvinder Gill

By Mr Talvinder Gill
Colorectal surgery

Mr Talvinder Gill is a highly experienced consultant colorectal surgeon who has a specialist interest in laparoscopic colorectal surgery. He is skilled in single incision laparoscopic surgery and scarless surgery. Mr Gill is also a lecturer and offers courses to GPs on advanced laparoscopic surgery, bowel cancer, and colorectal disease.

He is the most experienced in single incision laparoscopic colorectal surgery in the UK and performs surgery with this technique for almost all colorectal procedures. He studied at the Institute of Medical Sciences at Banaras Hindu University where he graduated with an MBBS, he later went on to gain a Masters of Surgery at the Institute of Medical Sciences and a fellowship at the Royal College of Physicians and Surgeons. Mr Gill also completed a laparoscopic colorectal fellowship in Colchester.

He gained a chair at the North England Cancer Network in 2012, he was a multidisciplinary clinical committee member at The Association of Coloproctology of Great Britain and Ireland, and became the cancer services committee member at the Royal College of Surgeons in 2013. Mr Gill is currently an SACC specialist advisor and also an education and training committee member for the Association of Colorectal Surgery. Mr Gill has also had work published in a range of well-known journals, on topics including, single port laparoscopic colorectal surgery, the role of ADRC in anal fistulae, and transanal endoscopic surgery for early rectal cancer.

  • Related procedures
  • Gastroscopy
    Pelvic floor reconstructive surgery
    Robotic surgery
    Rectal surgery
    Anal fistula surgery
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.