Speedboat™ is a novel multimodal endosurgical device.  It utilizes the use of advanced bipolar energy for cutting/dissection and super-high frequency microwave energy for coagulation. The trans-anal platform comprises the Gelpoint® as an access port and the Airsea®l as a CO2 exchange apparatus. It creates an “invisible pneumo- dissection” effect due to intraluminal CO2 pressure gradient. This study aims to evaluate the efficacy of Speedboat assisted Endoscopic Submucosal Dissection (S-ESD) with and without the trans-anal platform (TAP) in the management of complex distal colorectal polyps as well as the speed of dissection.

Data, from a prospectively collected clinical audit (2018-2025) was analyzed. Cases were divided into two groups, the pre-TAP group (2018-2020 TAP not introduced) and the post-TAP group (2021-2025) which was further analyzed in two subgroups, the non-TAP and the TAP group when the platform was indicated. Lesion characteristics, long and short axis length, and time dissection were collected. Lesion surface (cm²), Speed (cm2/hr) and Clinical outcomes were compared between the three groups. 

Over the study period, a total of 291 consecutive patients [55.7% male, age 72 (IQR: 64-77)] had a distal colorectal lesion completely excised using S-ESD with median surface of 13.73cm² (IQR:6.86-25.12), long axis  5,0 cm (IQR: 3.5-7.0) and speed 10.23cm2/hr (IQR:6.97-16.75).

Pre-TAP group included 58 patients [58.6% male, age 72 (IQR 65-77)] with median surface of 9.81cm² (IQR:6.72-15.89), long axis 4.5cm (IQR: 3.5-6.1) and speed 7.15 (IQR: 6.86-9.31). Post-TAP group included 233 patients with distal polyps had S-ESD [54.9%male, age 72 (IQR: 64-77)] with median surface of 15.11 cm² (IQR:6.96-28.26), long axis 5.0cm (IQR: 3.5-7.25) and speed 12.19 (IQR: 7.18-18.84)].

Within the post-TAP group, the TAP subgroup included 145 patients who underwent  S-ESD [60.0% male, age 71(IQR: 63-76) with median surface 15.70 (IQR: 8.83-34.34) and speed 12.18 (IQR: 7.06-18.59). In the non-TAP subgroup 88 patients were subject to S-ESD [46.6% male, age 72 (IQR: 64-79), median surface 11.77 (IQR: 4.90-20.16)] and speed 11.99 (IQR: 7.39-21.81).

Overall, the speed and surface were significantly increased in the post-TAP group when compared with the pre-TAP group (p<0.001 and p=0.006 respectively. There was not a statistical significant difference in dissection speed within the the post-TAP subgroups (p=0.563). The median surface of the polyps removed were significantly larger in the TAP subgroup (p=0.002). No statistically significant difference in regards with age and gender was found among any of the groups.

The use of TAP modality combined with S-ESD appears to facilitate excision of distal lesions with larger surface with reasonable speed over time. A randomized trial and/or an international registry to investigate the role of pneumo-dissection is warranted.