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

Table 1 Comparative summary

Feature	ESD	Transanal endoscopic microsurgical submucosal dissection	Transanal minimally invasive surgery
En bloc resection rate	High (> 85%)	Very high (> 90%)	Moderate (60%-80%)
Procedure time	Long	Moderate	Short
Learning curve	Steep	Moderate (faster than ESD)	Gentle
Morbidity	Perforation risk (approximately 5%-10%)	Low (due to traction and access)	Low
Use in large lesions	Effective, technically complex	Particularly suited for > 5 cm lesions	Limited by exposure/size
Access platform	Flexible endoscope	Rigid proctoscope (Buess platform)	Flexible single-port device
Sphincter preservation	Yes	Yes	Yes
Long-term outcomes	Excellent	Excellent	Good

ESD: Endoscopic submucosal dissection.