Hybrid transanal endoscopic microsurgery: a novel approach to rectal neoplasm excision

Abstract

Rectal neoplasm excision is a challenging issue in gastrointestinal endoscopy and surgery. This technical note describes a hybrid method for the excision of challenging rectal neoplasms. The procedure consists of the combined use of classic endoscopy and transanal endoscopic microsurgical instrumentation for full-thickness removal of a recurrent rectal polyp in a patient who had previously undergone endoscopic excision of a Tis rectal adenocarcinoma, located behind the valve of Houston and 9cm from the anal verge. The lesion was removed completely in 50min with no operative complication. The patient's postoperative course was uneventful, and she was discharged after 5days. Pathological examination of the specimen confirmed complete resection of the lesion with adequate disease-free margins. Hybrid transanal endoscopic microsurgery successfully combines the precision and flexibility of classic endoscopy with the radicality and safety of transanal endoscopic microsurgery for the treatment of demanding benign or early-stage malignant rectal tumours.