title: A new approach: endoscopic submucosal dissection using the Clutch Cutter® for early stage digestive tract tumors.
abstract: Endoscopic submucosal dissection (ESD) is accepted as minimally invasive therapy for early stage digestive tract tumors. It has allowed the achievement of histologically curative en-bloc resection of early stage digestive tract tumors regardless of size, including the resection of previously non-resectable tumors. Although numerous electrosurgical knives have been developed for ESD, technical difficulties and high complication rates (bleeding and perforation) have limited their use worldwide. Furthermore, conventional ESD usually needs several devices for each session. We developed the Clutch Cutter® (CC), which can grasp and incise the targeted tissue using electrosurgical current, to resolve such ESD-related problems. The ESD procedure using the CC is as follows: after marking using the CC and the injection of a solution into the submucosa, the lesion is separated from the surrounding normal mucosa by complete incision around the lesion using the CC. A piece of submucosal tissue is grasped and cut with the CC using electrosurgical current to achieve submucosal exfoliation. Intraoperative bleeding is also treated by the CC. Reported clinical studies showed that ESD using the CC is a safe, simple, easy-to-learn, technically efficient (en-bloc resection rate 100%), and a single-device method for the dissection of early stage digestive tract tumors. This new approach is promising to become the worldwide method of choice for early stage digestive tract tumors because it is technically simple and safe to perform.
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, 3-83 Yoshio, Iizuka, Japan. kakahoshi2@aol.com
authors.forename: Kazuya
authors.initials: K
authors.lastname: Akahoshi
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Akahane
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Motomura
authors.forename: Masaru
authors.initials: M
authors.lastname: Kubokawa
authors.forename: Syouichi
authors.initials: S
authors.lastname: Itaba
authors.forename: Keishi
authors.initials: K
authors.lastname: Komori
authors.forename: Naotaka
authors.initials: N
authors.lastname: Nakama
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oya
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D004067:Digestive System Neoplasms / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation* / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods