Chen Shengsen, Zhou Danping, Yu Jiangping, Ruan Rongwei, Liu Yuanshun, Li Yandong, Shen Qiwen, Wang Shi
Department of Endoscopy, Institute of Basic Medicine and Cancer (IBMC), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Chinese Academy of Sciences, Hangzhou, China.
Front Med (Lausanne). 2022 May 13;9:888635. doi: 10.3389/fmed.2022.888635. eCollection 2022.
Endoscopic submucosal dissection (ESD) is technically difficult with high rates of complications, such as perforation and bleeding. We aimed to explore the safety and cutting efficiency of a novelly devised bipolar knife for ESD procedure.
Taking a traditional monopolar knife as a reference, the safety and feasibility of the novel bipolar knife were evaluated by an animal experiment and a human study. Furthermore, we assessed the usefulness and advantage of this novel bipolar knife by using the finite element method.
A porcine experiment confirmed that there was no significant difference in wound size and cutting speed between the monopolar and bipolar knives. The thermal damage and histopathological scores produced by the two knives were similar. In addition, the porcine experiment and patients' study identified that the incidence of postoperative complications, such as bleeding, perforation, and infection, had no statistical difference between the monopolar and bipolar groups. Finally, the finite element model showed that the length and depth of thermal damage caused by the bipolar knife were, respectively, 102.77-117.98% and 80.87-84.53% of those caused by the monopolar knife at the same power.
The novel bipolar knife was theoretically safer than the monopolar knife and, at least, was confirmed not inferior to the monopolar knife in operability and cutting efficiency. Thus, the novel bipolar knife can be an alternative device choice for ESD.
内镜黏膜下剥离术（ESD）技术难度大，并发症发生率高，如穿孔和出血。我们旨在探讨一种新设计的用于ESD手术的双极电刀的安全性和切割效率。
以传统单极电刀为对照，通过动物实验和人体研究评估新型双极电刀的安全性和可行性。此外，我们使用有限元方法评估了这种新型双极电刀的实用性和优势。
一项猪实验证实，单极电刀和双极电刀在伤口大小和切割速度方面无显著差异。两种电刀产生的热损伤和组织病理学评分相似。此外，猪实验和患者研究表明，单极组和双极组术后并发症（如出血、穿孔和感染）的发生率无统计学差异。最后，有限元模型显示，在相同功率下，双极电刀引起的热损伤长度和深度分别为单极电刀的102.77 - 117.98%和80.87 - 84.53%。
新型双极电刀在理论上比单极电刀更安全，且至少在可操作性和切割效率方面不逊色于单极电刀。因此，新型双极电刀可作为ESD的替代设备选择。
