Colonoscopy: Transverse Colon - LST-NG Tumor - Resection

Problem: Middle aged patient with a large LST-NG tumor in the transverse colon was referred for resection after prior failed attempts as an alternative to surgery.
I used general anesthesia to stabilize the transverse colon as the LST-NG tumors are very difficult to resect - they tend not to lift easily; snare tends to slip and with considerable difficulty one can grab the lesion; they tend to bleed easily and are at high risk for perforation. Noted the scar at the anal side of the polyp, hence I went up a little bit to inject (9 cc of saline with Methylene Blue). After complete resection, used hot biopsy avulsion to clear any minute residual polyps. Subsequently used APC 0.8 L flow and 35 Watts to ablate the edge. For closure, I moved the patient to supine and found a longitudinal fold in the center of the resection (possible from underlying longitudinal muscle/taenia coli) to close the defect in two layers. Pathology: Tubular adenoma.