Commentary

10.1055/a-2663-8549

Therapeutic endoscopy here mimics surgical exposure: a dual-scope setup uses a cholangioscope to deliver biliary forceps for adjustable countertraction, approximating triangulation in rectal endoscopic submucosal dissection (ESD).

However, this remains short of true surgical triangulation. Both instruments are still delivered coaxially through a single natural orifice without a stable platform, independent instrument arms, or fixed spatial separation. Field crowding, scope–scope interference, and limited simultaneous suction, dissection, and hemostasis persist. The approach functionally augments ESD visualization but does not yet constitute transanal flexible surgery with full multiquadrant control.

This is an elegant step that mimics surgical exposure principles and inches toward triangulation, but its current nature is that of an ESD traction adjunct rather than real transanal flexible surgery.

Publication History

Article published online:
15 December 2025