Post written by Thomas R. McCarty, MD, and Hiroyuki Aihara, MD, PhD, from the Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA.

In this video presentation, we describe a case of successful en bloc resection of a 60-mm laterally spreading tumor granular type (LST-G) rectal lesion using an endoscopic submucosal tunneling dissection technique utilizing a novel bipolar radiofrequency and microwave-powered device [Speedboat-RS2 (CREO Medical Ltd, United Kingdom)]. We first review the device, which includes a retractable 26-gauge needle for submucosal injection, dual energy capabilities including bipolar radiofrequency cutting and hemostasis with microwave coagulation, and insulated hull to prevent thermal injury to the muscularis propria. Next, we demonstrate a step-by-step technique using this novel endoscopic submucosal dissection knife to facilitate safe and effective removal of a non-invasive rectal lesion, accomplished in under an hour.

This case nicely demonstrates the endoscopic submucosal tunneling dissection technique and highlights several potential advantages of this novel dual-energy capable device. These include use of bipolar radiofrequency dissection and microwave coagulation for hemostasis. Additionally, the insulated base may help to prevent thermal injury to the deeper tissues during endoscopic submucosal dissection (ESD).

We hope this video case presentation educates other endoscopists on the value of minimally invasive resection techniques, like ESD, for appropriate lesions. Additionally, we hope to inform other endoscopists regarding this novel device and endoscopic submucosal tunneling dissection technique, which may reduce procedural complexity, decrease procedure-associated adverse events, shorten procedure times, and increase adoption of ESD.

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