# Thulium laser–assisted colorectal endoscopic submucosal dissection

## TL;DR

A thulium laser was successfully used for colorectal endoscopic submucosal dissection, showing potential as a safer and more precise alternative to traditional tools.

## Contribution

Demonstrates the feasibility of thulium laser in colorectal endoscopic submucosal dissection with no adverse events.

## Key findings

- Thulium laser–assisted ESD was completed in 75 minutes without coagulation forceps.
- No intraoperative or delayed adverse events occurred during the procedure.
- The final pathology showed a tubulovillous adenoma with clear margins.

## Abstract

Thulium laser is emerging as an alternative energy source in endourologic applications due to its precise cutting capabilities, reliable hemostasis, and limited thermal injury. These features have promoted its adoption in urology and sparked interest in gastrointestinal endoscopy. In endoscopic submucosal dissection (ESD), thulium laser offers potential advantages over conventional electrosurgical knives, including shallow penetration depth, powerful coagulation, and precise dissection.

We describe the use of thulium laser–assisted colorectal ESD in a 68-year-old man with a 3.5-cm rectal polyp. Submucosal injection was followed by incision and complete dissection using the thulium laser.

En bloc thulium laser–assisted ESD of the rectal lesion was completed in 75 minutes without the requirement for coagulation forceps. There were no intraoperative or delayed adverse events. The final pathology was tubulovillous adenoma with clear margins.

This case demonstrates the feasibility and potential benefits of thulium laser–assisted colorectal ESD. The precise cutting capabilities, shallow penetration depth, and effective coagulation properties of the thulium laser make it an exciting prospect as an alternative to conventional electrosurgical knives for colorectal ESD. Thulium laser–assisted ESD may offer a safe and effective alternative to conventional knives in colorectal ESD. Larger prospective studies are needed to confirm its safety and efficacy.