Management of early rectal cancer; current surgical options and future direction

Table 1 Overview of techniques for minimally invasive transanal surgery

	TEM	TEO	TAMIS
Rigid/flexible platform	Rigid	Rigid	Flexible
Upfront cost	High	Intermediate	Low
Cost per case1	High	Low	Intermediate
Learning curve	Long	Long	Short
Stable pneumoperitoneum	Most stable	Intermediate stability	Lowest stability
Limitations for proximal/distal lesions	-	-	Potential limitations with very proximal or very distal lesions
Post-operative anal dysfunction	Possibly higher rates due to use of 4 mm rectoscope	Possibly higher rates due to use of 4 mm rectoscope	-

¹Based on economic study conducted by Serra-Aracil et al[35]. TEM: Transanal microscopy surgery; TEO: Transanal endoscopic operation; TAMIS: Transanal minimally invasive surgery.