An osmotic agent, consisting in a Voluven based solution with indigo carmine, is injected in the submucosal space at the level in which the mucotomy is planned.
A submucosal tunnel is created from a point 5 cm proximal to the lesion. It is extended the distally until the tumor is identified, using a combination of blunt dissection and coagulation.
A pearl-white submucosal tumor is identified during the dissection. The lesion is dissected from the submucosal space and larger feeding vessels are coagulated with coagulation forceps and then sectioned. The distal attachment provides proper traction in order to assist the dissection.