A 90-DEGREE DISSECTION PLANE ROTATION: A NEW HORIZON UNLOCKED. ESD MUSCLE-FRIENDLY APPROACH.

Different ESD strategies are applied to facilitate the resection of large lesions like the tunneling technique and pocket creation method. One of the challenges during tunneling in large lesions is the narrow working space, looping with the risk of muscle or mucosal injury. We describe a novel approach rotating the dissection plane 90 degrees where muscle and mucosa are on the right and left. we start a wide mucosal incision from the caecal side followed by a wide incision from the anal side compared to the standard small incision before starting dissection in the altered 90 degrees plane decreasing the risk of muscle or mucosal injury and improving visualization of penetrating vessels