Fig. 4.

 Near-side approach method. a-1 Initial incisions are made with Needle knife on the lateral sides of the lesion and a mucosal incision is made with IT knife/IT knife-2 for about one-third or one-half of the circumference on the near (anal) side of the field of view. a-2 Alternatively, a mucosa incision is made with Dual knife for about one-third or one-half of the circumference on the near (anal) side. b Submucosal dissection is performed with IT knife/IT knife-2 on the near (anal) side. c A circumferential mucosal incision is completed and the submucosal dissection is performed with IT knife/IT knife-2.