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Updated: May 1, 2026

Surgical Robot-Assisted Transanal Specimen Extraction Radical Sigmoidectomy Without an Auxiliary Abdominal Incision
Published on: June 13, 2025
Investigating deeper: muscularis propria to natural orifice transluminal endoscopic surgery
Kazuki Sumiyama1, Christopher J Gostout2, Hisao Tajiri3
1Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
Abstract:
Submucosal endoscopy with a mucosal flap (SEMF) safety valve technique is a global concept in which the submucosa is a free working space for endoscopic interventions. A purposefully created intramural space provides an endoscopic access route to the deeper layers and into the extraluminal cavities. The mucosa overlying the intramural space is protective, reducing contamination during natural orifice transluminal endoscopic surgery (NOTES) procedures and providing a sealant flap to repair the entry point and the submucosal space. In addition to NOTES, SEMF enables endoscopic achalasia myotomy, histologic analysis of the muscularis propria, and submucosal tumor removal.
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