Experimental application of pulsed laser-induced water jet for endoscopic submucosal dissection: Mechanical investigation and preliminary experiment in swine

Chiaki Sato, Toru Nakano, Atsuhiro Nakagawa, Masato Yamada, Hiroaki Yamamoto, Takashi Kamei, Go Miyata, Akira Sato, Fumiyoshi Fujishima, Masaaki Nakai, Mitsuo Niinomi, Kazuyoshi Takayama, Teiji Tominaga, Susumu Satomi

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Background and Aim A current drawback of endoscopic submucosal dissection (ESD) for early-stage gastrointestinal tumors is the lack of instruments that can safely assist with this procedure. We have developed a pulsed jet device that can be incorporated into a gastrointestinal endoscope. Here, we investigated the mechanical profile of the pulsed jet device and demonstrated the usefulness of this instrument in esophageal ESD in swine. Methods The device comprises a 5-Fr catheter, a 14-mm long stainless steel tube for generating the pulsed water jet, a nozzle and an optical quartz fiber. The pulsed water jet was generated at pulse rates of 3 Hz by irradiating the physiological saline (4°C) within the stainless steel tube with an holmium-doped yttrium-aluminum-garnet (Ho:YAG) laser at 1.1 J/pulse. Mechanical characteristics were evaluated using a force meter. The device was used only for the part of submucosal dissection in the swine ESD model. Tissues removed using the pulsed jet device and a conventional electrocautery device, and the esophagus, were histologically examined to assess thermal damage. Results The peak impact force was observed at a stand-off distance of 40 mm (1.1 J/pulse). ESD using the pulsed jet device was successful, as the tissue specimens showed precise dissection of the submucosal layer. The extent of thermal injury was significantly lower in the dissected bed using the pulsed jet device. Conclusion The results showed that the present endoscopic pulsed jet system is a useful alternative for a safe ESD with minimum tissue injury.

Original languageEnglish
Pages (from-to)255-263
Number of pages9
JournalDigestive Endoscopy
Volume25
Issue number3
DOIs
Publication statusPublished - 2013 May

Keywords

  • early esophageal tumor
  • endoscopic submucosal dissection (ESD)
  • holmium-YAG laser
  • medical engineering
  • minimally invasive surgery
  • therapeutic endoscopy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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