FEASIBILITY OF A NEW ELECTROSURGICAL UNIT “AUTOCONIII400” FOR ENDOSCOPIC SUBMUCOSAL DISSECTION

Aims:

Endoscopic submucosal dissection (ESD) is very useful for treating large superficial gastrointestinal tumors in en bloc resection manner, but it requires high skill. Especially beginners tend to cut the tissue slowly in ESD, and so it make the tissue burnt. Therefore, the ability of the electrosurgical unit and its setting are extremely important for ESD. VIO series (ERBE, Germany) is often employed for ESD, but usefulness of other electrosurgical units for ESD is not fully elucidated. Herein, we investigated the feasibility of the a new electrosurgical unit “AUTOCONIII400” (KARL STORTZ, Germany) for endoscopic submucosal dissection.

Methods:

We performed ESD for 15 colorectal, 16 gastric, and 4 esophageal superficial neoplasms with AUTOCONIII400 for endoscopic submucosal dissection between February 2018 and May 2018. FlushKnife BT (Fujifilm, Japan) was used for 14 colorectal, 6 gastric, and 4 esophageal lesions. Jet B-knife (Zeon Medical Co. Japan) was used only for 2 colorectal lesions. ITKnife 2 (Olympus, Japan) was used only for 9 gastric lesions. We adjusted the settings to find the appropriate modes and settings for ESD.

Results:

Average tumor diameter, resected specimens diameter, and average procedure time were 22.8 mm, 40.2 mm, and 43.8 minutes, respectively. All lesions were resected without any complications. Appropriate settings were GastroKNIFE, medium, effect3 for mucosal cutting, Forced Mix mode, effect2, 50 – 60W, for submucosal dissection, and Non-cutting mode, effect2, 80W for hemostasis. Cutting ability of GastroKNIFE mode and Forced Mix mode were excellent, and even fat rich tissue and fibrotic tissue was easily cut with less burning effect. On the other hand, a little slow cutting in submucosal dissection was needed to prevent bleeding.

Conclusions:

AUTOCONIII400 was feasible for colorectal, gastric and esophageal ESD. Further studies are needed to fully evaluate its usefulness.