development of biomedical technology has led to an increase in the possibilities of endoscopic treatment of patients with growths in the digestive tract. Today's techniques pose increasing challenges for the endoscopic team to perform endoscopic procedures for the removal of growths in the safest possible conditions for patients, which will reduce the patient's stay in the hospital and allow faster recovery after the procedure. The endoscopic submucosal dissection method that is available to us today uses a combination of bipolar radiofrequency (RF) cutting and microwave coagulation for hemostasis, making it suitable for various endoscopic procedures. The device consists of a needle for submucosal injection and tissue irrigation, and an insulated body which prevents thermal injuries. Although it seems like a simple technique, it requires teamwork and coordination between the endoscopist and the nurse/technician in order to successfully perform the procedure, given the long duration of the procedure itself.

in this abstract we will present case report of endoscopic submucosal dissection technique in 65 years old female patient by new endoscopic device.

the patient presented to the gastroenterology clinic on the recommendation of general practitioner due to weight loss, abdominal pa in and aversion to certain foods. We performed  gastroscopy which was normal, and a colonoscopy was recommended. The colonoscopy revealed a laterally spreading lesion in the rectum approximately 8 centimeters from the anocutaneous border, measuring approximately 40 x 30 millimeters in diameter, LST-G (Paris IIa+Is), predominantly JNET 2a superficial vascular pattern, with a lesser extent JNET 2b. A pelvic magnetic resonance imaging scan was recommended to assess invasion of the rectal wall and surrounding structures, where it was determined that there was a possible shallow infiltration of the muscular layer of the wall without penetration into the serosa. By decision of the council consisting of a gastroenterologist, digestive surgeon, oncologist, pathologist and radiologist, an endoscopic submucosal dissection was performed using a Speed ​​boat knife. The procedure lasted 4.5 hours. It proceeded without complications. Two endoscopic clips were implemented  in the distal rectum because  there was a lesion of the muscle layer. Visible blood vessels were coagulated and a preventive hemostatic clip was placed on lumen of one blood vessel. The resected area was removed with forceps and stretched on cork. The dimensions were 47 x 35 mm. The patient was admitted to the hospital  for observation and was discharged home the next day with the recommendation of rest and a lighter diet. Six months after the procedure, a control rectoscopy was performed, which showed a neat scar without residue  as well as a neat vascular drawing under WLE and NBI. It was recommended endoscopic follow-up in one year.

during the procedure the coordination of the endoscopist and the nurse/technician stands out and is necessary  for the success of the procedure.