title: Feasibility Study of the Three-Dimensional Flexible Endoscope in Endoscopic Submucosal Dissection: An ex vivo Animal Study.
abstract: OBJECTIVE
  Clinical application of 3-dimensional (3D) technology for flexible endoscopes has not been reported. We developed a 3D flexible endoscope and conducted a feasibility study of endoscopic submucosal dissection (ESD) in porcine stomach.
  
  
  METHODS
  Four endoscopists used a 3D flexible endoscope to perform a total of 8 ESD procedures on resected porcine stomachs. We assessed the en bloc resection rate, perforation rate, and mechanical issues that arise during ESD. A visual analog scale (0, 2D superior; 100, 3D superior) was used to evaluate the depth perception, sense of security of the procedure, and eyestrain of 3D visualization.
  
  
  RESULTS
  En bloc resection was achieved in all cases and there were no cases of perforation or mechanical issues. Depth perception and sense of security were rated 85.5 ± 12.4 and 70.7 ± 9.7 respectively (mean ± SDs). Eyestrain was rated high for 3D visualization (mean ± SDs, 12.6 ± 8.6).
  
  
  CONCLUSIONS
  ESD using a 3D flexible endoscope was technically feasible. The endoscopists reported good depth perception and a high sense of security when using 3D visualization but also noted strong eyestrain.
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kikuchi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.forename: Kosuke
authors.initials: K
authors.lastname: Nomura
authors.forename: Takahito
authors.initials: T
authors.lastname: Toba
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kuribayashi
authors.forename: Masami
authors.initials: M
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Furuhata
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Mitani
authors.forename: Shu
authors.initials: S
authors.lastname: Hoteya
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iizuka
mesh_terms: D000818:Animals; D001248:Asthenopia / Q000209:etiology*; D019723:Endoscopes; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005240:Feasibility Studies; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D023421:Models, Animal; D010465:Perception; D013552:Swine
keywords: Endoscopic procedure; Endoscopy; Eyestrain; Gastric cancer; Gastrointestinal endoscopy; Laparoscopy; Three-dimensional images