Endoscopic surgery - exploring the modalities

Table 1 Characteristic of various endoscopic submucosal dissection knives

Type	Manufacturer	Description	Comments
Needle-knife type
Insulated tip knife	Olympus	Ceramic ball attached to the tip of the knife	Insulator helps to prevent perforation. Small ceramic ball is suitable to operate on thinner submucosal plane; e.g., in the esophagus and colon
Hook knife	Olympus	Tip of the knife is right-angled	Submucosal tissue is hooked and pulled before incision, lessen the risk of perforation
Flex knife	Olympus	Knife formed by soft, flexible loop cutting wire with adjustable length	Less risk of perforation. Distal end of the sheath is thick to serve as stopper to allow precise control of incision depth
Dual knife	Olympus	Small ball-like process on the tip, knife can be fixed in two positions - retracted or extended	Ball tip prevents slipping
Flush knife	Fujinon	Short needle knife that comes in 5 different projection lengths Water emission through the lumen of the needle	Water jet is activated by a foot pedal, helps to washout blood at operative field and debris at the tip of knife. Provide better visualization and less time consuming without having to switch instruments
Splashneedle	Pentax	Similar to Flush knife
Mucosectomy	Pentax	Circumferentially insulated knife with single cutting wire on the side of the tip	Insulated plastic sheath can lie on the muscular layer, allowing safe dissection by cutting wire on the submucosal plane
Grasping type scissor forceps
SB knife	Sumitomo Bakelite	Rotatable monopolar scissors, surrounded with no-conductive coating. Clawed and curved tip	Large insulated claw prevents injury to the muscular layer
Clutch Cutter	Fujinon	Thin serrated cutting scissor, insulated on the outer forcep, rotatable	Serrated edges help to grasp tissue better