Assistant skill in gastric endoscopic submucosal dissection using a clutch cutter

Figure 1 Procedure with a clutch cutter. A: Opening and rotation of the clutch cutter; B: Horizontal cutting line; and C: Target tissue successfully grasped by the clutch cutter.

Figure 2 Endoscopic submucosal dissection procedure with a clutch cutter. Representative images of each step of the endoscopic submucosal dissection with a clutch cutter procedure. A: Mock lesion made in the porcine stomach; B: Circumferential mucosal incision with a clutch cutter; C: Clip-with-thread traction method attached to the proximal edge of the lesion; and D: Submucosal dissection with a clutch cutter.

Figure 3 Positioning of the staff and instruments during endoscopic submucosal dissection with a clutch cutter. A: Endoscopic submucosal dissection with a clutch cutter assisted by an expert; B: Endoscopic submucosal dissection with a clutch cutter assisted by a non-expert.

Figure 4 Flowchart of this study. ESD-C: Endoscopic submucosal dissection with a clutch cutter; ESD-C-E: Endoscopic submucosal dissection with a clutch cutter assisted by an expert; ESD-C-NE: Endoscopic submucosal dissection with a clutch cutter assisted by a non-expert.