2,448
Views
5
CrossRef citations to date
0
Altmetric
Original Article

Learning curve for endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: use of the cumulative sum method

ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon & ORCID Icon show all
Pages 1234-1242 | Received 14 Jun 2020, Accepted 04 Aug 2020, Published online: 27 Aug 2020

Figures & data

Figure 1. Stag-Beetle Knife Jr.

Figure 1. Stag-Beetle Knife Jr.

Table 1. Baseline characteristics and procedure outcomes of all patients.

Figure 2. Learning curve for a satisfactory resection rate using moving average analysis. The purple and gray dotted line shows 95% CI. (A) Complete resection rate, (B) en bloc resection rate, and (C) curative resection rate. CI: confidence interval.

Figure 2. Learning curve for a satisfactory resection rate using moving average analysis. The purple and gray dotted line shows 95% CI. (A) Complete resection rate, (B) en bloc resection rate, and (C) curative resection rate. CI: confidence interval.

Figure 3. CUSUM resection speed (min/cm2) against procedure number. The red line shows the decision interval, whereas the purple line indicates the outlier. CUSUM: cumulative sum.

Figure 3. CUSUM resection speed (min/cm2) against procedure number. The red line shows the decision interval, whereas the purple line indicates the outlier. CUSUM: cumulative sum.

Table 2. Tumor and procedure characteristics among the three phases.

Figure 4. Patient flowchart.

Figure 4. Patient flowchart.

Figure 5. Survival curve.

Figure 5. Survival curve.

Figure 6. Schema for SB Knife Jr and the conventional tip-type knife. SB Knife Jr has a forceps length of 3.5 mm, an opening width of 4.5 mm, and an opening angle of 105°. Assuming a fan-shaped dissection surface, a single grasp and dissection action enables the clinician to cut approximately 11.2 mm2 of tissue. In contrast, assuming a rectangular dissection surface, the tip-type knife with a 1.5 mm forceps length requires a horizontal movement of approximately 7.5 mm to cut the same length of tissue. In the difficult-to-operate large intestine, these movements require advanced endoscopic techniques.

Figure 6. Schema for SB Knife Jr and the conventional tip-type knife. SB Knife Jr has a forceps length of 3.5 mm, an opening width of 4.5 mm, and an opening angle of 105°. Assuming a fan-shaped dissection surface, a single grasp and dissection action enables the clinician to cut approximately 11.2 mm2 of tissue. In contrast, assuming a rectangular dissection surface, the tip-type knife with a 1.5 mm forceps length requires a horizontal movement of approximately 7.5 mm to cut the same length of tissue. In the difficult-to-operate large intestine, these movements require advanced endoscopic techniques.