Background: Albeit, effective for treatment of early neoplasm, endoscopic submucosal dissection
(ESD) can be technically demanding and time consuming. Furthermore, use of multiple
instruments if often mandatory for performing various steps associated with the procedure.
Hence, we aimed to design, create and evaluate a new instrument for ESD, the “Endo-Dissector”.
Methods: Gastric ESDs of areas from 15 to 30 mm including circumferential incision and coagulation
of bleeding vessels were performed using a single device. Incision was done with the
prototype instrument in a closed position using cutting current. Submucosal dissection
was performed using an approach comprised by four steps: 1) open jaws of instrument,
2) grasp fibers, 3) elevate tip to avoid contact with muscle layer, 4) dissect fibers
using cutting current. Bleeding was terminated by grasping vessels and applying coagulation
current.
Results: The procedure was successfully performed in a total of 6 pigs. The new instrument
was useful performing all single steps as needed (incision, dissection, coagulation
of bleeding vessels). Time needed for the complete intervention was 35 to 70 minutes.
Conclusions: The new instrument has potential advantages in comparison with standard instruments
used for ESD. All steps can be performed with a single instrument and the technique
of lifting submucosal fibers during dissection potentially decreases risk of perforation.
