Electrosurgical knife with the water-jet function of tip-type during endoscopic treatment injection

Satoshi Ono; Yasuko Kurihara; Fumiya Hirose; Hajime Aoki; Kyohei Mejima; Shun Ito; Shun Osumi; Seika Hatori; Kazushi Fukagawa; Shosuke Hosaka; Miho Matsukawa; Ryosuke Kobayashi; Nobuyoshi Yamazaki; Mitsuhiro Fujishiro

doi:10.1002/deo2.165

Electrosurgical knife with the water-jet function of tip-type during endoscopic treatment injection

DEN Open. 2022 Sep 20;3(1):e165. doi: 10.1002/deo2.165. eCollection 2023 Apr.

Authors

Satoshi Ono^{1

2

3}, Yasuko Kurihara⁴, Fumiya Hirose⁴, Hajime Aoki⁴, Kyohei Mejima², Shun Ito², Shun Osumi¹, Seika Hatori¹, Kazushi Fukagawa¹, Shosuke Hosaka^{1

2}, Miho Matsukawa¹, Ryosuke Kobayashi⁵, Nobuyoshi Yamazaki⁵, Mitsuhiro Fujishiro³

Affiliations

¹ Department of Gastroenterology and Gastrointestinal Endoscopy Tokyo Metropolitan Geriatric Medical Center Tokyo Japan.
² Department of Gastroenterology Chiba-Nishi General Hospital Chiba Japan.
³ Department of Gastroenterology The University of Tokyo Hospital Tokyo Japan.
⁴ Department of Clinical Engineering Chiba-Nishi General Hospital Chiba Japan.
⁵ Department of Surgery Chiba-Nishi General Hospital Chiba Japan.

Abstract

Objectives: This study aimed to objectively evaluate the water-jet-functioned electrosurgical knife injection performances in a desktop experiment.

Methods: Five types of water-jet-functioned electrosurgical knives, including two injection styles of sheath-type (A: DualKnife J, KD-655L; B: FlushKnife, DK2620-J-B20S; C: Splash M-Knife, DN-D2718B; D: ISSEN, SN1650-20) and tip-type (E: ORISE ProKnife, M00519361) were evaluated. These knives were compared with an injection needle (Control: SuperGrip 25G) as a control. The injection speed under constant pressure and the injection efficiency for each knife against prepared porcine stomach mucosa were evaluated. The additional clear gel injections using an injection needle were observed using an indigo blue-colored gel to evaluate the difference between the locations of water-jet holes.

Results: Four types of knives, except for A, showed significantly higher water-jet speeds (A: 0.79 ± 0.03 g/20 s, B: 2.56 ± 0.05 g/20 s, C: 3.09 ± 0.06 g/20 s, D: 2.86 ± 0.05 g/20 s, and E: 1.79 ± 0.03 g/20 s) compared to that of the control (1.21 ± 0.03 g/20 s). Meanwhile, significantly higher efficacy of injection was found in the tip-type water-jet function knife, second to the injection needle (Control: 37.2% ± 35.5%, A: 20.9% ± 20.2%, B: 1.1% ± 2.2%, C: 6.2% ± 12.6%, D: 12.5% ± 15.6%, and E: 33.3% ± 32.2%). An additional injection experiment revealed that the injection with a piercing tip into the gel could achieve sufficient additional injection inside the stacked clear gel.

Conclusions: The tip-type water-jet function electrosurgical knife is preferable for effective submucosal injection during endoscopic treatments.

Keywords: desktop experiment; electrosurgical knife; endoscopic submucosal dissection; injection; porcine model.