Refining Colorectal ESD Techniques with DualKnife J

✔　The DualKnife J has a disk shaped knife tip that enables hooking and cutting even in a situation where the muscle layer stands perpendicularly.

✔　Stable, effective dissection with DualKnife J was achieved even in challenging situations, such as rich fatty tissue or submucosal hematoma.

✔　Hemostasis and vessel management was achieved by coagulating with the DualKnife J.

✔　Switching to a lateral approach by pulling the DualKnife J back toward the center, similar to dissection with an ITknife, can sometimes be effective when the muscle layer is close to the target tissue in a narrow space.

✔　Aim the appropriate injection site to:

• Avoid injury of the blood vessel

• Target the loose submucosal layer just above the muscle layer

✔　Strongly contacting the tip of the ceramic sheath is the secret for effective injection with DualKnife J, since the injection solution is coming from the it.

✔　Applying the coagulation current briefly while pushing the sheath into the tissue to reduce the distance between the DualKnifeJ and the submucosal layer can help enable effective injection.

✔　Advantages of the water pressure method contributing to safe and effective submucosal dissection:

• Stable visualization of the submucosal layer from initial submucosal dissection

• Facilitated identification of the submucosal layer, differentiated from vessel, fat tissue, muscle layer

• Hooking the tissue edge facilitated by water jet

✔　The DualKnife J demonstrates good cutting capability underwater due to its high electro density. Changing the electrosurgical unit setting from under air condition is not necessary.