title: Gastric endoscopic submucosal dissection using novel 2.6-mm articulating devices: an ex vivo comparative and in vivo feasibility study.
abstract: OBJECTIVE
  The conventional procedure of endoscopic submucosal dissection (ESD) is technically demanding. This study investigated the efficiency of novel articulating devices (maximum diameter 2.6 mm), which can be used with commercially available, standard endoscopes.
  
  
  METHODS
  In an ex vivo comparative study, eight endoscopists were divided into novices and experienced operators, and performed ESD using new devices and the conventional setup. An in vivo animal experiment was performed by two experts. Procedure times for incision and dissection were recorded, and unit times for circumferential length and area of specimens were calculated.
  
  
  RESULTS
  All procedures were successfully completed with en bloc resection. In the ex vivo study, the unit procedure times for incision and dissection by novices were significantly shorter using the new system (P < 0.01 and P < 0.05), whereas there was no significant difference for experienced endoscopists. Perforation occurred during one procedure in which the new system was used. The in vivo experiments were successfully completed without adverse events.
  
  
  CONCLUSIONS
  ESD using novel articulating devices was feasible. These devices were able to reduce the procedure time for novices.
authors: Department of Research and Development for Surgical Support Systems, Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.
authors: Ryu
authors: R
authors: Nakadate
authors: Department of Research and Development for Surgical Support Systems, Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.
authors: Shotaro
authors: S
authors: Nakamura
authors: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Tomohiko
authors: T
authors: Moriyama
authors: Department of Research and Development for Surgical Support Systems, Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.
authors: Hajime
authors: H
authors: Kenmotsu
authors: Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Susumu
authors: S
authors: Oguri
authors: Department of Research and Development for Surgical Support Systems, Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.
authors: Jumpei
authors: J
authors: Arata
authors: Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Munenori
authors: M
authors: Uemura
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Kenoki
authors: K
authors: Ohuchida
authors: Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Tomohiko
authors: T
authors: Akahoshi
authors: Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Tetsuo
authors: T
authors: Ikeda
authors: Department of Research and Development for Surgical Support Systems, Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.
authors: Makoto
authors: M
authors: Hashizume
mesh_terms: D000818:Animals; D002983:Clinical Competence; D004210:Dissection / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000295:instrumentation*; D006801:Humans; D008953:Models, Anatomic; D013552:Swine