Background: Transanal endoscopic microsurgery (TEM), a procedure developed by Buess et al. requires a specially designed surgical rectoscope system, and adequate training for its operation is mandatory. In order to simplify the performance of TEM, and to allow the use of additional surgical instruments and devices, we have developed a new rectoscope tube.

Methods: The forward half of the tube can be opened longitudinally by hand. Our working insert platform is hollowed and includes a channel for an endoscope. The resection procedure can be performed under normal atmospheric pressure. This newly developed rectoscope system has already been employed clinically. TEM was performed using our original forward lifting hood rectoscope tube in 20 patients, including 12 cases of sessile adenoma and eight cases of early carcinoma.

Results: The forward hood of the tube was opened to the maximum angle of 25° in eight patients and 15–20° in the other 12 patients. The visible field of the rectal interior was extended in direct proportion to the angle. Through our working insert platform, instruments and devices could be used for either laparoscopic or open surgery.

Conclusions: These modifications have made TEM easier and will therefore make the procedure available to more surgeons.