Are you afraid of rectal surgery? Let's learn about a new, non-invasive method (TEMS)!

It's normal to feel scared when your doctor tells you that you have a tumor in your rectum, the lower part of your large intestine. You might be thinking, "Oh, I'm going to have to cut open your stomach, I'm going to have to stay in the hospital for a few days, it's going to hurt a lot," right? But don't worry. Technology is very advanced today. Today, we're talking about Transanal Endoscopic Microsurgery (TEMS) , a special surgical procedure that removes tumors like this without making any incisions in your stomach, using small instruments inserted through your rectum.

Simply put, what is TEMS?

TEMS is a minimally invasive surgical procedure used to remove tumors and small cancers from your rectum. In the past, removing a tumor from your rectum would have required a major abdominal surgery. In this TEMS procedure, the surgeon inserts a special instrument through your anus and uses a small camera and surgical instruments to remove the tumor.

The biggest advantage of this is that since there are no incisions on the outside of the body , you will feel much less pain, heal faster, and have fewer complications than after major surgery.

What is the difference between TEM and TAMIS?

You may have also heard of TAMIS. These two methods are somewhat similar, but there is a slight difference.

• TEMS (Transanal Endoscopic Microsurgery): This uses a long, thick tube-like instrument called a ``Rectoscope.'' The camera and other instruments are passed through this tube.
• TAMIS (Transanal Minimally Invasive Surgery): This uses a small, round, flexible, gel-like port. It is inserted through the anus and the tumor is removed using the same instruments used for laparoscopic surgeries.

The doctor will assess your condition and choose the method that best suits you based on the location of the tumor.

Who is TEMS surgery best suited for?

This surgery is not for everyone, but in some cases it is a very good option.

• For those who have difficulty enduring major surgery due to other health problems (e.g. heart disease, diabetes).
• For those with early stage rectal cancer.
• For young people with non-cancerous (benign) tumors.
• For anyone who wants to avoid major surgery, if the doctor decides it's appropriate.

However, if the position of your spine makes it difficult for the instrument to reach the tumor, or if your rectum is narrowed (stenosis), this procedure may not be possible. This is all determined by your surgeon.

Conditions treated with TEMS surgery

This surgery is often performed to remove tumors in the rectum. It is used to treat the following conditions:

How do you prepare before surgery?

Preparing for this is similar to preparing for a colonoscopy. The main thing is to completely clean your intestines . This will allow the doctor to see the inside of your rectum clearly. For this, your doctor will give you a special laxative.

Typically you will receive instructions like this:

• Avoid eating solid foods the day before surgery.
• Drink only clear liquids (water, salt water, Jeevani) 12-24 hours before surgery.
• Avoid eating or drinking anything from midnight on the day of surgery.
• If you are taking anything like blood thinners, be sure to tell your doctor about it and stop taking them a few days in advance, as per his or her advice.

What happens during the surgery?

You won't feel anything during this procedure because the surgery will be performed under general anesthesia, which means you will be completely asleep. Here's what happens during the surgery:

1. The surgeon inserts the instrument ``Rectoscope`` through the anal opening into the rectum.

2. The rectum is slightly inflated with gas to better visualize the area around the tumor.

3. A camera and delicate surgical instruments are inserted through the rectoscope and the tumor or polyp, along with some surrounding healthy tissue, is cut out and removed.

4. The incision is then closed with either dissolvable stitches or small metal clips.

What is it like after surgery?

You may experience some discomfort after surgery. During the first 24 hours, you may experience:

• A tube (`catheter`) placed in your bladder to drain urine.
• Give the body the fluids it needs through a saline infusion (an `IV line`) into a vein in your arm.
• Antibiotics (IV antibiotics) given through saline for about 24 hours to prevent infection.

You can start eating and drinking about a day after the surgery. You will usually be able to go home after a day or two in the hospital .

What are the advantages of this method?

The TEMS method has many advantages over a laparotomy. Major surgery can sometimes lead to urinary control problems, sexual dysfunction, and even the need for a permanent colostomy. The TEMS method reduces many of these risks.

Isn't there a risk in this?

As with any surgery, there is a small risk, but the risk is much lower than a tummy tuck.

• Bleeding
• Having an infection
• Rectal or abdominal pain
• Difficulty urinating (`Urinary retention`)
• Sudden need to defecate (`Fecal urgency`)

If something like this occurs, doctors are ready to treat it.

If you have these symptoms, see a doctor immediately.

If you experience any of the following symptoms after returning home, call your doctor immediately or go to the hospital's Emergency Department (ETU).

• Excessive bleeding
• Fever or feeling cold
• Difficulty urinating
• Unbearable stomach or rectal pain

If it's cancer, is this the only treatment?

If rectal cancer is detected in its early stages, and the tumor is completely removed with TEMS surgery, other treatments may not be necessary. However, for some people, depending on the nature of the tumor, your doctor may recommend chemotherapy or radiation therapy in addition to this surgery. This will all be determined after examining your condition.

TEMS, Transanal Endoscopic Microsurgery, rectal surgery, rectal cancer, non-incisional surgery, rectal surgery sinhala, rectal tumor sinhala