Combination of needle-knife and hemostatic forceps in a novel hybrid knife (Blossom-knife) improves endoscopic submucosal dissection in porcine model
As a widely used treatment of early gastrointestinal neoplasms, endoscopic submucosal dissection (ESD) requires specifically designed surgical instruments, primarily an endoknife for dissection and hemostatic forceps for hemostasis . Because switchover of different instruments makes ESD challenging in terms of skills, as well as time-consuming   , there is an urgent need to develop hybrid instruments that can be used to perform ESD more safely and easily . Here we report on the use of our newly invented hybrid knife (Blossom-knife), which perfectly integrates a needle-knife and hemostatic forceps ([Fig. 1]), to achieve effective hemostasis and reliable dissection during ESD in a porcine model ([Video 1]).
Video 1 Use of a new combined needle-knife and hemostatic forceps (Blossom-knife) for endoscopic submucosal dissection (ESD) in a porcine model showing: maneuvering of the handle to transform between needle-knife mode and hemostatic mode; confirmation of the successful functioning of the device in both modes; complete ESD being performed in the rectum of a young pig.
The multiple functions of the Blossom-knife were tested in a 40-kg pig. It was found that, using needle-knife mode, the Blossom-knife was able to both beautifully mark the thin mucosa of the esophagus ([Fig. 2 a]) and smoothly incise the thick mucosa of the stomach ([Fig. 2 b]). Meanwhile, the hemostatic forceps mode performed outstandingly in stopping bleeding from an arteriole in the stomach ([Fig. 2 c]). As stable design functions were confirmed, the Blossom-knife was used to perform a complete ESD in the rectum. After saline solution was injected into the submucosal layer, mucosal incision and submucosal dissection were conducted using the needle-knife mode ([Fig. 2 d]). When intraoperative hemorrhage and suspected vessels were encountered, instead of changing instruments, the needle-knife mode could be directly converted to the hemostatic forceps mode to control the bleeding quickly and accurately. The en bloc resection of a 2 × 4-cm piece of mucosa ([Fig. 2 e]) was achieved within 20 minutes, without any perforation occurring ([Fig. 2 f]).
In this study, the newly developed dissection and coagulation-fused Blossom-knife was shown to perform margin marking, circumferential incision, submucosal dissection, and vascular coagulation during the different steps of the ESD procedure. This new device makes ESD much easier and safer, and potentially faster, meaning that ESD will be more amenable for endoscopists.
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20 August 2020 (online)
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