Transanal Endoscopic Microsurgery - State of the Art

The first description of surgery for rectal cancer was reported by the French surgeon Lisfranc who described a total of nine patients operated trough a perineal-transanal approach (Lisfranc, 1830). Although more recently gaining popularity, transanal techniques have long been used for the treatment of rectal diseases and were promoted by the work of Sir Alan Parks at St. Marks Hospital in London in the 1950s (Parks, 1970). This conventional surgical approach is well suited for the management of selected low rectal lesions; on the contrary, removal of lesions in the middle and upper rectum are less feasible due to the limited accessibility and inadequate exposure afforded by standard instrumentation. For these reasons, those more proximal lesions have historically been tackled by more radical surgical approaches, like abdominal low anterior, abdominoperineal, transsacral, and transsphincteric resections.