Conclusion
Transanal endoscopic microsurgery is an innovative procedure that allows excision of lesions in the mid- and upper rectum, with curative intent, short hospitalization, and few perioperative complications. However, it demands acquisition of specific technical skills and requires a well-orchestrated surgical team and very expensive equipment. Nonetheless, for a very few caudally selected patients, TEM allows a minimally invasive approach with achievement of long-term results quite comparable to conventional radical procedures. Because of the training, expense, and limited number of patients in whom it may be used, TEM is likely to remain in the hands of a limited number of surgeons.
Intraoperative colonoscopy has rapidly expanded in its potential applications during colorectal procedures and is often instrumental in changing the planned procedure. In experienced hands, it allows precise localization of intraluminal or vascular pathology with minimal impact on operative time; this technique should be available to all surgeons. Acknowledgments. The authors thank the Richard Wolf Medical Instruments Corporation for providing photographs of the TEM instruments.