Watch the complete PRIME algorithm in action: from MRS detection and deep margin optical diagnosis to real-time EID plane selection. A 75-minute teaching case demonstrating how to achieve R0 resection in early rectal cancer with the REACT tool.
EID precision teaching - demonstrates the core philosophy of EID: it is all about precision and about knowing you are doing what you are doing and the reason why you are doing it
"I would switch here to EID and call this a muscle retraction sign."
The PRIME algorithm represents a paradigm shift in how we approach early rectal cancer endoscopically. Standing for deeP-maRgin optIcal diagnosis and endoscopic resection algorithM for Early rectal cancer, this systematic approach ensures we make the right resection plane decision based on real-time tissue assessment rather than predetermined strategies.
"So deep margin optical assessment. What we're doing here, you can clearly see the lesion, you can clearly see the muscle."
"R zero is, should be the goal. It's probably the goal of surgeons anyway."
The procedure begins with careful lesion assessment. In this case, the lesion displays BLINK positivity, central depression, and converging folds - features concerning for deep invasion. Rather than proceeding directly with standard ESD, the operator creates a pocket to assess the submucosal plane.
Upon identifying the muscle retraction sign during pocket creation, deep margin optical diagnosis confirms the need to change planes. The decision to switch to EID is made in real-time, demonstrating the adaptive nature of the PRIME algorithm.
"We will encounter muscle retraction sign. So the question is will we need to get R zero?"
This case demonstrates integration of the REACT tool for procedural support, highlighting how digital resources can enhance complex endoscopic procedures.
This video is essential viewing for interventional endoscopists managing rectal lesions, particularly those looking to expand beyond standard ESD into intermuscular dissection techniques. The surgical-endoscopic collaboration also provides valuable anatomical perspectives for understanding safe dissection zones.
Watch the full 75-minute procedure to master the PRIME algorithm and see how real-time decision-making leads to optimal oncological outcomes.
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