USEFULNESS OF A CLUTCH CUTTER FOR SURGEONS WITH EXPERIENCE OF PERFORMING COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION IN LESS THAN 100 PATIENTS AT AN INSTITUTION WITHOUT TUTORS

Aims The usefulness of a clutch cutter (CC), a scissor-type knife, for colorectal endoscopic submucosal dissection (CESD) has recently been reported. However, there has been no study on the usefulness of a CC for surgeons with experience of performing CESD in less than 100 patients at an institution without tutors. Therefore, the usefulness of a CC for such surgeons was examined in the present study.

Methods Between April 2018 and August 2019, 76 patients underwent CESD in Kushiro Rosai Hospital. Of those patients, 69 were included in this study.

Surgeon: CESD was previously performed in 24 patients under the guidance of tutors at other institutions. When using CC, paper cutting technique (Abiko S et al. Endoscopy, 2019 October) is occasionally used.

Results A comparison of 39 patients who underwent the procedure using needle-type knives and 30 patients who underwent the procedure using the CC showed that the resection time was significantly shorter in the latter group (median: 145 vs. 81 min). The median resection speeds for each of the nine patients in blocks 1 to 7 were 2.5, 3.4, 3.2, 3.2, 3.2, 5.5 and 5.5 cm²/h. In blocks 5-6 (45-54 patients), there was an increased resection speed of 2.3 cm²/h for one block, just overlapping with the time of complete transition for use of the CC. Even in the moving average graph of the nine patients in blocks 5-6, the mean resection speed was ≤4 cm²/h until the 45th patient; however, after the 54th patient, the mean resection speed was ≥5.5 cm²/h. There were differences between the two groups in frequencies of microperforation (7.6% vs. 0%) and muscular injury (12.8% vs. 3.3%).

Conclusions Even at an institution without tutors, the use of the CC by surgeons with experience of performing CESD in less than 100 patients increases the learning curve.