Endoscopy 2007; 39: E144
DOI: 10.1055/s-2006-925320
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection using a novel irrigation wiper-knife

K. Kume1 , M. Yamasaki1 , K. Kanda1 , I. Yoshikawa1 , M. Otsuki1
  • 1 Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
Further Information

M. Otsuki, M. D.

Third Department of Internal Medicine, School of Medicine

University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu 807-8555Japan

Fax: +81-93-692-0107

Email: mac-otsk@med.uoeh-u.ac.jp

Publication History

Publication Date:
04 July 2007 (online)

Table of Contents

Endoscopic submucosal dissection techniques require special skills and the procedure can be very prolonged [1] [2]. In response these drawbacks, we have designed a new dissection knife, the “wiper-knife”, which simplifies the procedure.

We recently developed a hood-knife that facilitates endoscopic submucosal dissection by sliding the hood-knife with coagulation current along the muscle layer [2]. However, we considered that it was essential to be able to perform endoscopic submucosal dissection more mechanically. The wiper-knife was made by installing a needle-knife in exchange for the snare forceps we used in the hood-knife. The needle-knife was crossed by and fixed with a handling wire, which was inserted through tubes at either side of the hood.

Zoom Image
Zoom Image

Figure 1 The irrigation wiper-knife. a The irrigation tube (4) and needle-knife (1) were glued to the exterior surface over the hole, but only the needle-knife was intersected by and fixed with the handling wire (2). b The schematic representation shows more clearly how the needle-knife moves like a windshield wiper (double-headed red arrow).

The endoscopic submucosal dissection procedure using the wiper-knife is carried out as follows (Figure [2]): a grasping forceps is passed through an accessory channel and used to push the lesion away from the muscle layer; submucosal exfoliation is then performed by moving the wiper-knife like a windshield wiper with coagulation current on the muscle layer to separate the submucosa from the muscle layer. We resected three specimens in animal models (pigs) using this wiper-knife. The average diameter of the resected specimens was 30 mm.

Zoom Image

Figure 2 Schematic representation of the endoscopic submucosal dissection procedure using the wiper-knife.

Endoscopic submucosal dissection can be safely and easily carried out under direct vision using this method. Another advantage of the wiper-knife is that endoscopic submucosal dissection and endoscopic hemostasis can be carried out while simultaneously applying adequate irrigation [2] [3] [4] [5] [6].

Endoscopy_UCTN_Code_TTT_1AO_2AG

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References

M. Otsuki, M. D.

Third Department of Internal Medicine, School of Medicine

University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu 807-8555Japan

Fax: +81-93-692-0107

Email: mac-otsk@med.uoeh-u.ac.jp

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References

M. Otsuki, M. D.

Third Department of Internal Medicine, School of Medicine

University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu 807-8555Japan

Fax: +81-93-692-0107

Email: mac-otsk@med.uoeh-u.ac.jp

Zoom Image
Zoom Image

Figure 1 The irrigation wiper-knife. a The irrigation tube (4) and needle-knife (1) were glued to the exterior surface over the hole, but only the needle-knife was intersected by and fixed with the handling wire (2). b The schematic representation shows more clearly how the needle-knife moves like a windshield wiper (double-headed red arrow).

Zoom Image

Figure 2 Schematic representation of the endoscopic submucosal dissection procedure using the wiper-knife.