Copyright ©The Author(s) 2015.
World J Gastrointest Surg. Nov 27, 2015; 7(11): 326-334
Published online Nov 27, 2015. doi: 10.4240/wjgs.v7.i11.326
Table 1 Characteristic of various endoscopic submucosal dissection knives
Needle-knife type
Insulated tip knifeOlympusCeramic ball attached to the tip of the knifeInsulator helps to prevent perforation. Small ceramic ball is suitable to operate on thinner submucosal plane; e.g., in the esophagus and colon
Hook knifeOlympusTip of the knife is right-angledSubmucosal tissue is hooked and pulled before incision, lessen the risk of perforation
Flex knifeOlympusKnife formed by soft, flexible loop cutting wire with adjustable lengthLess risk of perforation. Distal end of the sheath is thick to serve as stopper to allow precise control of incision depth
Dual knifeOlympusSmall ball-like process on the tip, knife can be fixed in two positions - retracted or extendedBall tip prevents slipping
Flush knifeFujinonShort needle knife that comes in 5 different projection lengths Water emission through the lumen of the needleWater 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
SplashneedlePentaxSimilar to Flush knife
MucosectomyPentaxCircumferentially insulated knife with single cutting wire on the side of the tipInsulated plastic sheath can lie on the muscular layer, allowing safe dissection by cutting wire on the submucosal plane
Grasping type scissor forceps
SB knifeSumitomo BakeliteRotatable monopolar scissors, surrounded with no-conductive coating. Clawed and curved tipLarge insulated claw prevents injury to the muscular layer
Clutch CutterFujinonThin serrated cutting scissor, insulated on the outer forcep, rotatableSerrated edges help to grasp tissue better
Table 2 Randomised controlled trials that reported on no significant difference in major outcomes between transvaginal cholecystectomy and conventional laparoscopic cholecystectomy
Ref.Study typeType of TVCOutcome
Median/min Duration of surgery (min)
Median/min Length of stay (d)
Median/min Pain score
Kilian et al[18]RCTHybrid68553413
Noguera et al[19]RCTHybrid64.8547.04113.944.65
Borchert et al[20]RCTHybrid65.164.22.812.811.812.03
Table 3 Summary of reported outcome data for endoscopic restrictive gastroplasty
TechniqueStudy designExcess BMI/weight loss (%)Effects of comorbiditiesPostoperative complications
Transoral gastroplasty[44]Prospective multicentre study with 67 patients enrolled52.2% for patients with baseline BMI < 40; 41.3% for patients baseline BMI > 40Successful reduction of HbA1c to 5.7% (baseline of 7%), improvement in triglyceride level2 patients had respiratory insufficiency and asymptomatic pneumoperitoneum, respectively. Both were successfully managed conservatively
Average BMI: 41.5 (range 35.0-52.7)
Follow up period: 12 mo
Endoluminal vertical gastroplasty using Bard EndoCinch suturing system[45]Prospective, single centre observational studyOverall EWL of 58.1%NENo serious adverse events reported
Average BMI: 39.9 (range 28.0-60.2)Patients with BMI < 35 have highest EWL of 85.1%
Follow up period: 12 mo
Endoscopic transmural gastric plication using Incisionless Operating Platform[30]Prospective single centre49.4% EWL at 6 moNEMinor postoperative side effects, i.e., fever, sore throat, stomach pain, nausea, vomiting and chest pain
Average BMI: 36.7 (range 28.1-46.6)
Follow up period: 6 mo