Endoscopic submucosal dissection, transanal endoscopic microsurgical submucosal dissection, and transanal minimally invasive surgery in rectal lesions

Abstract

The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques. Endoscopic submucosal dissection (ESD), transanal endoscopic microsurgical submucosal dissection (TEM-ESD), and transanal minimally invasive surgery (TAMIS) offer precision and reduced morbidity for treating these conditions. This minireview evaluates the efficacy, safety, and clinical outcomes of ESD, TEM-ESD, and TAMIS, highlighting their roles in the contemporary management of rectal lesions. A desktop research study with a particular focus on ESD, TEM-ESD, and TAMIS for rectal lesions was conducted. Key outcomes assessed include complete resection rates, complication rates, recurrence rates, and functional outcomes following the procedure. ESD is noted for its high rate of en bloc resection with minimal invasiveness, suitable for large or flat lesions. TEM-ESD has demonstrated similar efficacy, with additional benefits including shorter procedure times and a more favorable learning curve, compared to traditional ESD, as evidenced by recent comparative studies. TAMIS offers a less invasive option with enhanced visualization and accessibility, supporting its use in a broader range of rectal lesion cases. ESD, TEM-ESD, and TAMIS are all effective therapeutic options for rectal lesions, each presenting unique advantages depending on lesion characteristics and patient factors.

Keywords: Endoscopic submucosal dissection; Transanal endoscopic microsurgical submucosal dissection; Transanal minimally invasive surgery; Rectal adenomas; Early rectal cancer; Minimally invasive colorectal surgery; En bloc resection; Local excision techniques

Core Tip: Minimally invasive en bloc resection techniques have revolutionized the management of large rectal lesions, especially non-pedunculated polyps and early rectal cancers. This minireview compares three major approaches, namely, endoscopic submucosal dissection (ESD), transanal endoscopic microsurgical submucosal dissection (TEM-ESD), and transanal minimally invasive surgery (TAMIS), in terms of efficacy, safety, and technical feasibility. While ESD and TEM-ESD offer high en bloc resection rates with low recurrence, TAMIS is gaining popularity for its ergonomic advantages and ease of use. The minireview provides a critical perspective on indications, limitations, and future innovations, guiding clinicians in selecting the most appropriate technique based on lesion characteristics and institutional expertise.