Course Overview: This is a three day practical hands on course with expert tuition involving live surgery demonstrations. The course aims to introduce delegates to the technique of TEMS, to teach indicators for TEMS, to teach the basic skills required to carry out TEMS safely. The course will take place at the RCSEd but will also include a day at the Western General Hospital in Edinburgh. On completion of the course after attending this course delegates should be able to: 1) Identify the instrumentation required and set-up for TEM surgery. 2) Perform under supervision a full thickness excision /closure. 3) Perform under supervision a SM resection / full thickness. 4) List the pitfalls of TEM surgery and describe how these can be addressed.