The operating anoscope (Fig. 1) is introduced and the polyp is identified. The base of the polyp is infiltrated with a weak epinephrine solution (1:300 000) so that the mucosa is lifted off the submucosa. A 1-cm margin around the polyp is included in the excision, particularly for villous lesions, so that the entire mucosa and polypoidal lesion are excised, leaving a bare rectal wall at the base. A polyp that cannot be easily excised in the plane suggests malignant invasion, in which case the operation should be immediately converted to a full disc excision of the lesion.
Surgical procedures in the rectum, such as resection of sessile polyps, have mainly been performed with the use of retractors. Surgical manipulation inside the rectal cavity using retractors has its disadvantages. The surgical view is restricted to the area between the branches of the retractors, the blades of
the retractor obstruct parts of the rectum, and the area located higher than the retractor tends to collapse, again obstructing the view. The surgical instruments and the hands of the surgeon restrict the direct vision of the operating field. For these reasons, transanal surgical procedures have been mostly applied for lesions in the lower third of rectum.
Depending on each situation, parts of the tumour-bearing area of the rectum can be prolapsed towards the anal verge, thereby utilising the standard technique in most cases up to 7-8 cm from the anal verge.
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