Endoscopic submucosal injection: a novel technique facilitating dissection in transanal minimally invasive surgery (TAMIS)

Transanal minimally invasive surgery (TAMIS) is a surgical platform that enables local excision of rectal tumours,originally described by Atallah et al. [1]. It has mainly beenused for the excision of benign lesions, but has also beenused in the management of early malignant lesions. As withany local approach to rectal malignancy lack of lymph noderesection is a concern [2]. TAMIS has the advantages ofbeing easy and safe to perform [3]. Dissection in TAMIS isachieved by traction and counter-traction in a rather confinedspace (the pneumorectum), which can be difficult. Visualisation of tissue planes can be challenging. We adopted awell-developed endoscopic technique known as endoscopicsubmucosal injection (ESI) to facilitate dissection...