Fig. 1

TEMS surgical workflow. A typical surgical flow from landmarking of the rectal polyp to dissection, lesion removal and closure of the rectal wall defect. The key milestones of a TEMS procedure are detailed in images a-j: [a] Baseline lesion in view after setup; [b] Application of landmark “dots” to outline the lesion; [c] Dissection of the wall through the mucosa and muscle; [d,e] Circumferential removal of the lesion; [f,g] Final removal and extraction of the specimen; [h,i] Closure of the rectal wall defect with a suture; and [j] Application of a metal clip to secure the suture and ensure complete closure.