DESCRIPTION OF PROCEDURE AND KEY FINDINGS

En block resection using Bipolar-Microwave assisted Endoscopic Submucosal Dissection modality of the rectal malignant lesion (T1 sm3) was achieved  with targeted separation of the layers of the bowel wall. Gradual increase CO2 pressure every 2mm Hg by CO2 exchange apparatus allowed ease separation of the circular layer in 2 stages: first peeling off the superficial surface of the circular followed by a deeper dissection to the intermuscular space. With aid of the bipolar/microwave device and a smoke free CO2 exchange apparatus, the intermuscular dissection was achieved by pulsed injections prior to the bipolar cutting modality.Follow up endocyroscopy check confirmed granulation tissue.