Feasibility Study of the Three-Dimensional Flexible Endoscope in Endoscopic Submucosal Dissection: An ex vivo Animal Study

Digestion. 2017;95(3):237-241. doi: 10.1159/000468924. Epub 2017 Apr 1.

Abstract

Background/aim: Clinical application of 3-dimensional (3D) technology for flexible endoscopes has not been reported. We developed a 3D flexible endoscope and conducted a feasibility study of endoscopic submucosal dissection (ESD) in porcine stomach.

Methods: Four endoscopists used a 3D flexible endoscope to perform a total of 8 ESD procedures on resected porcine stomachs. We assessed the en bloc resection rate, perforation rate, and mechanical issues that arise during ESD. A visual analog scale (0, 2D superior; 100, 3D superior) was used to evaluate the depth perception, sense of security of the procedure, and eyestrain of 3D visualization.

Results: En bloc resection was achieved in all cases and there were no cases of perforation or mechanical issues. Depth perception and sense of security were rated 85.5 ± 12.4 and 70.7 ± 9.7 respectively (mean ± SDs). Eyestrain was rated high for 3D visualization (mean ± SDs, 12.6 ± 8.6).

Conclusions: ESD using a 3D flexible endoscope was technically feasible. The endoscopists reported good depth perception and a high sense of security when using 3D visualization but also noted strong eyestrain.

Keywords: Endoscopic procedure; Endoscopy; Eyestrain; Gastric cancer; Gastrointestinal endoscopy; Laparoscopy; Three-dimensional images.

MeSH terms

  • Animals
  • Asthenopia / etiology*
  • Endoscopes*
  • Endoscopic Mucosal Resection / adverse effects
  • Endoscopic Mucosal Resection / instrumentation*
  • Endoscopic Mucosal Resection / methods
  • Equipment Design
  • Feasibility Studies
  • Gastric Mucosa / surgery
  • Gastroscopy / adverse effects
  • Gastroscopy / instrumentation*
  • Gastroscopy / methods
  • Imaging, Three-Dimensional / adverse effects
  • Imaging, Three-Dimensional / instrumentation*
  • Imaging, Three-Dimensional / methods
  • Models, Animal
  • Perception
  • Swine