Abstract
Since the introduction of transanal endoscopic microsurgery, local excision of “early”
rectal lesions has offered the possibility to reduce the invasiveness of treatment
for the limited disease. Flexible endoscopy techniques allow today different alternatives
consisting of endoscopic mucosal resection or endoscopic submucosal dissection. The
first is a straightforward and relatively easy technique, but it prevents a correct
pathological staging of the lesion due to fragmentation and the verification of disease-free
margins. The second relies on operators' audacity depending on their increasing experience
due to the limited progress in technology. What is the preferable technique today
is questionable. All the methods have pros and cons. The future certainly will see
the use of ideal systems, allowing the possibility of precision surgery for partial-
or full-thickness excision, depending on intraoperative findings, and the extension
above the rectosigmoid junction. Miniaturized flexible robotic devices may represent
the solution for both issues.
Keywords
early rectal lesions - transanal endoscopic microsurgery - endoscopic mucosal resection
- endoscopic submucosal dissection - microrobots
