Stavros N. Stavropoulos, MD, performs a rectal endoscopic submucosal dissection with ORISE-TRS and Creo speedboat ESD knife. The patient is a 61-year-old man with history of metastatic melanoma on second cycle of immunotherapy was noted on surveillance PET scan to have hypermetabolic mass (SUV 13) in rectosigmoid colon suspicious for primary carcinoma. Colonoscopy showed a 3cm Paris lla+llc rectal lesion 15cm from anal verge. pathology consistent with tubulovillous adenoma with HGD. This video is part of the 11th Annual Long Island Live Endoscopy Course, Frontiers of Endoscopic Surgery.