Currently, EMR and ESD are carried out alone in endoscopy suites. If a perforation is noted, an attempt may be made to close the hole with endoscopic clips. If a large perforation is made or if clips are not adequate, surgery is then necessary to deal with the problem. There is inevitably a delay before surgery is carried out, which is not ideal. The simultaneous use of laparoscopic and advanced endoscopic methods in the operating room setting allows a surgical endoscopist to rationally employ ESD methods for large right-sided polyps.