title: A new 3D-printed overtube system for endoscopic submucosal dissection: first results of a randomized study in a porcine model.
abstract: OBJECTIVE
  Endoscopic therapy of early malignant alterations can be difficult and cumbersome. Our research study group took advantage of new methods for rapid prototyping (i. e. 3D printing) to design and test an overtube system with two manipulator arms at the tip. Both arms can be steered independently from each other by a dedicated user platform.
  
  
  METHODS
  This animal study involved a randomized evaluation of the new overtube device for endoscopic submucosal dissection (ESD) compared with a conventionally performed ESD. In total, 12 ESDs in six pigs were performed. Six ESDs were performed in the stomach and six in the colon. Size (in cm(2)) of resected specimens, the time needed to perform endoscopic resection, and adverse events were assessed.
  
  
  RESULTS
  The overtube-assisted ESD was faster and therefore more effective than the conventional ESD technique (0.45 ± 0.24 cm(2)/min vs. 0.22 ± 0.11 cm(2)/min; P = 0.029). Only one adverse effect was recorded in the conventional group.
  
  
  CONCLUSIONS
  The overtube-assisted ESD was feasible in an animal model. ESD can be performed more quickly and potentially more effectively with the newly designed overtube device compared with the conventional ESD technique.
authors.affiliation: Department of Internal Medicine, University of Ulm, Ulm, Germany.
authors.forename: Eugen
authors.initials: E
authors.lastname: Zizer
authors.affiliation: Institute of Micro Technology and Medical Device Technology, Technical University of Munich, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Roppenecker
authors.affiliation: Department of Internal Medicine, University of Ulm, Ulm, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Helmes
authors.affiliation: Institute for Anesthesiological Pathophysiology and Process Engineering, University of Ulm, Ulm, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hafner
authors.affiliation: Institute of Micro Technology and Medical Device Technology, Technical University of Munich, Munich, Germany.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Krieger
authors.affiliation: Institute of Micro Technology and Medical Device Technology, Technical University of Munich, Munich, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Lüth
authors.affiliation: Department of Internal Medicine, University of Ulm, Ulm, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
mesh_terms: D000818:Animals; D003106:Colon / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000295:instrumentation*; D061646:Operative Time; D066330:Printing, Three-Dimensional; D013270:Stomach / Q000601:surgery*; D013552:Swine