Since 2006, the Department of General Surgery, PUMCH took the lead in the Chinese mainland to perform Transanal Endoscopic Microsurgery (TEM). It treated more than 500 cases of benign and malignant rectal lesions, and clinically proved the safety and effectiveness of TEM on localized rectal tumors fit for local removal. The research, which long focused on expanded application of TEM and guideline formulation, received the third prize of 2016 Medical Achievement Award of PUMCH.

Traditional local rectal removal was made through propping open the anus. For a lesion 5cm away from the anus, however, problems included poor vision, limited space for operation and difficulty in precise removal. In TEM, a single-site endoscope goes through the anus, and the operator, through 3 to 6-time 3D binocular vision or the endoscopic imaging system, uses precision tools to reach the lesion directly, and finishes a series of operations including excision, bleeding stopping and stitching. This significantly boosted the quality of local rectal removal. Using natural orifice, TEM boasts advantages of low risk, less bleeding, minimal invasion, reduced pain and quick recovery.

TEM was at first only used on the removal of benign lesion, like rectal adenoma. The team led by Professor Qiu Huizhong, Professor Lin Guole from General Surgery innovatively applied TEM to localized malignant tumor fit for local removal. It has been successfully applied to 58 cases of malignant rectal adenoma, 84 cases of early-stage rectal cancer, 116 cases of NET and 20 cases of GIST. The team also led the world in applying TEM to two cases of rectal malignant melanoma. All surgical margins were proved pathologically negative, without remnants of lesion. Numerous clinical reports retrospectively proved the effectiveness and safety of the new method.

Our hospital also applied TEM to individualized treatment of progressive rectal cancer. It brought good news to some patients who strongly desired to keep their anus, saved them from major invasive injury and, while ensuring treatment, improved the overall life quality of patients.

TEM requires a lot from the operator’s skills. The central technique is continued stitching under single-site endoscope. Professor Lin Guole, relying on his rich experience, applied TEM to the repair of recurring rectovaginal fistula, which restored two patients to normal life who had long been in miseries.