[Transanal endoscopic microsurgery and its significance in rectal surgery--a review]

Transanal endoscopic microsurgery is a novel endoscopic method. Primarily, it has been developed to manage pathological middle rectum conditions. Over the time, indication criteria for this procedure have become wider and, due to technical progress, more extensive procedures on distal and middle rectum, as well as perirectal transanal procedures, could be performed. At the present time, there are clearly specified technical conditions which limit the procedure's extent, in particular the distance from the anus and the extent of rectal circumference affection. At the same time, when the method started to be used for surgical management of malignant tumors, a question arised, i.e. when the use of surgical rectoscope remains beneficial for a patient and when this method shows inferior long-term outcomes, considering the rate of local relapses and long- term survival rates. Based on the 2007-2010 literature review, the author aims to present principles to be used in the process of making a decision when the miniinvasive approach should be used and, vice versa, in which conditions the benefit of radical surgery has been demonstrated.