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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a25145464
DOI: 10.1055/a-2514-5464
Original article

Novel device for blunt dissection in third space endoscopy: Preliminary animal study (with video)

Takashi Yokouchi 
1   Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University School of Medicine Graduate School of Medicine, Suita, Japan (Ringgold ID: RIN38637)
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Teppei Masunaga 
3   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan
,
Kurato Miyazaki
3   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan
,
Motohiko Kato 
4   Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
,
Shota Fujii
5   Sanyo Co Ltd, Tondabayashi, Japan
,
Kota Momose
1   Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University School of Medicine Graduate School of Medicine, Suita, Japan (Ringgold ID: RIN38637)
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Kotaro Yamashita
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Takuro Saito
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Koji Tanaka
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Kazuyoshi Yamamoto
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Tomoki Makino
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Tsuyoshi Takahashi
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Yukinori Kurokawa
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Hidetoshi Eguchi
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Yuichiro Doki
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
,
Kiyokazu Nakajima 
1   Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University School of Medicine Graduate School of Medicine, Suita, Japan (Ringgold ID: RIN38637)
2   Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Abstract

Background and study aims

Blunt dissection is not commonly performed in flexible endoscopic procedures. We developed a novel blunt dissection device and evaluated its feasibility, safety, and potential effectiveness in third space endoscopy procedures.

Materials and methods

The device consists of a cotton swab and a flexible shaft. To evaluate its functionality, creation of 4-cm submucosal tunnels in live swine stomachs was attempted by either blunt dissection using our device or sharp dissection using a standard monopolar knife. Data on factors such as completion rate, operating time, adverse events, necessity of submucosal injection, and dissected submucosal thickness were collected.

Results

Eighteen submucosal tunnels were successfully created (sharp: 9, blunt: 9) by two experienced endoscopists and one novice endoscopist. Median operating time was significantly shorter in the blunt dissection group (239 vs. 429 s, P = 0.008). In the sharp dissection group, the experienced endoscopists did not cause any muscle layer injuries, but the novice endoscopist caused muscle layer injuries in all cases. In the blunt dissection group, neither experienced nor novice endoscopists caused muscle layer injuries. The blunt dissection group required significantly fewer submucosal injections (0 vs. 5, P < 0.001). Median dissected submucosal thickness was similar between the groups.

Conclusions

Blunt dissection using our device was feasible, safe, and potentially effective in third space endoscopy procedures by shortening operating time, reducing submucosal injections, and potentially minimizing muscle layer injury.

Keywords

Endoscopy Upper GI Tract - POEM - Endoscopic resection (ESD, EMRc, ...) - Endoscopy Lower GI Tract - Endoscopic resection (polypectomy, ESD, EMRc, ...)


Publication History

Received: 16 July 2024

Accepted after revision: 07 December 2024

Article published online:
05 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Takashi Yokouchi, Teppei Masunaga, Kurato Miyazaki, Motohiko Kato, Shota Fujii, Kota Momose, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Kazuyoshi Yamamoto, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Hidetoshi Eguchi, Yuichiro Doki, Kiyokazu Nakajima. Novel device for blunt dissection in third space endoscopy: Preliminary animal study (with video). Endosc Int Open 2025; 13: a25145464.
DOI: 10.1055/a-2514-5464
 

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