Different roles of endoscopy nurse in endoscopic submucosal dissection (ESD) by a novel bipolar type of ESD knife compared to a standard knife

Aims Our aim was to compare roles and workload of endoscopy nurse in endoscopic submucosal dissection procedures performed with a standard needle-type knife (DualKnife, Olympus) and a novel bipolar knife (Speedboat, Creo Medical).

Methods Four endoscopy nurses with experience in assisting at least 4 ESD procedures with new bipolar knife and at least 10 ESD procedures with standard needle-type knife were interviewed by a questionnaire. It included description of specific roles during both types of procedures, and semi-quantitative assessment of workload perception regarding those roles and procedure alltogether. Subjective workload perception was graded with grades 1 to 5 (1 being minimal workload and 5 being maximal workload), and standard-type and novel-type procedures were compared for each procedure part/role.

Results Preparing the patient, endoscope and accessory was graded the same for each procedure type by all nurses – 3.25 average. Accessory exchange (needle, ESD knife, coagulation forceps) workload was graded 2.75 average in standard-type procedure, and 1.0 in novel-type procedures (as there are virtually no accessory exchanges with bipolar-type knife).

Manipulation of the knife was graded 2.0 for standard-type knife and 4.25 for novel-type knife, as novel bipolar knife requires constant involvement of the nurse with knife rotation according to plane of dissection. Lifting of submucosa was estimated to be easier with standard-type knife (2.25 vs. 3.75), and vessel precoagulation was easier with novel-type knife (2.25 vs. 2.75). Bleeding management required less workload with novel-type knife (2.25 vs. 3.0), as it doesn't require introducing coagulation forceps, grasping the vessel with it and electrosurgical unit settings change. Overall grade of workload perception was similar, 4.25 for. standard-type vs. 4.5 for novel-type knife, as ESD procedures are usually lenghty and require high level of focus during whole procedure.

Conclusions ESD procedures are difficult both for the endoscopist and endoscopy nurse, especially for larger lesions that require a long period of focus. New bipolar knife removes the need for accessory exchange and change of electrosurgical unit settings during larger vessel management, but requires more focus and work from the assistant during dissection due to the need for rotation of the knife. Submucosal injection is also somewhat more complicated due to knife rotation and opening of the needle. Overall difficulty and workload perception by endoscopy nurse seem to be similar for both ESD methods.

Publication History

Article published online:
15 April 2024