How I Do it: Flexible 3D endoscope for Endoscopic Submucosal Dissection

Abstract

Endoscopic submucosal dissection (ESD) is technically challenging due to lack of depth perception. This report investigated effect of 3D endoscope for ESD and translate the technique from bench to clinical. In preclinical porcine experiment, the performance of ESD using 3D endoscope was compared between experienced and novice endoscopist. All ESD were completed without perforation. The median operative time per surface area was significantly lower for experienced endoscopist than that of novice (197.9s/cm² vs 434.7s/cm²) (p=0.05). The second part is a prospective clinical experience to evaluate use of 3D endoscope for ESD. Ten patients received ESD performed using 3D endoscope. 4 patients had gastric ESD, two had duodenal ESD and 4 had sigmoid and rectal ESD. There was no complication, while ESD failed in one patient who had gastric neoplasia at anastomosis. The mean operative time was 99.4 minutes and the operative time per surface area resection was 391.s/cm². The operating endoscopist did not complain of motion sickness, while the assistants had some dizziness upon prolonged ESD procedure. This study showed that performance of ESD was safe and effective using 3D endoscope with an excellent 3D view enhancing depth perception. Future study should be conducted to compare 3D against 2D endoscope for ESD.

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