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Takamaru et al. Mini-invasive Surg 2022;6:15 https://dx.doi.org/10.20517/2574-1225.2021.120 Page 3 of 7
Figure 1. IT knife nano® with and without disk back of an insulated tip. (A) IT knife nano with a disk. A small disc is placed behind the
insulated tip. (B) IT knife nano without disk. Only a blade is used for the submucosal dissection.
Figure 2. Submucosal dissection using IT knife nano®. (A) The edge of submucosal tissue is recognized using the ST hood short type®.
(B, C) The blade of the IT knife nano approaches to the submucosal tissue. Then moving along the muscle layer (blue arrows),
submucosal dissection is performed safely. (A, D, E) The procedure is performed turn by turn in both sides (yellow arrows).
from both sides. It is better to check the direction of resection every two to three times of energizing. In
addition, even in cases with relatively large vessels, a longer coagulation wave can be applied to resection
without bleeding [Figure 4]. Moving or pushing up the lesions half resected using a sheath of IT knife nano
is sometimes effective when the operation field is difficult to recognize. In addition, the ST hood short type®
(Fujifilm Co, Tokyo, Japan) is also useful for maintaining the surgical field and a better direct view by
pushing up the lesions and their submucosa . Therefore, combining these techniques is one of the keys to
[5]
safe and effective colorectal ESD using the IT knife nano.
