title: Hybrid transanal endoscopic microsurgery: a novel approach to rectal neoplasm excision.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 9 cm from the anal verge.
  
  
  RESULTS
  The lesion was removed completely in 50 min with no operative complication. The patient's postoperative course was uneventful, and she was discharged after 5 days. Pathological examination of the specimen confirmed complete resection of the lesion with adequate disease-free margins.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Marrosu
authors.forename: P
authors.initials: P
authors.lastname: Paliogiannis
authors.forename: M W
authors.initials: MW
authors.lastname: Ruggiu
authors.forename: F
authors.initials: F
authors.lastname: Attene
authors.forename: M
authors.initials: M
authors.lastname: Trignano
authors.forename: F
authors.initials: F
authors.lastname: Scognamillo
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*
keywords: TEM; endoscopy; full thickness; polyps; rectal cancer