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Page 6 of 7 Takamaru et al. Mini-invasive Surg 2022;6:15 https://dx.doi.org/10.20517/2574-1225.2021.120

Figure 6. Pocket creation method (PCM) with tunneling technique with IT knife nano®. (A) A tunnel is made after continuing
submucosal dissection by PCM (yellow arrow). (B, C) The blade of the IT knife nano is put on the edge of the tunnel and moved a little
to the outside (blue arrow). (D-F) The procedure is performed repeatedly (direction to the blue arrow), and submucosal tissue is
resected safely even if fibrosis exists.

has superior hemostatic performance compared to the needle-type devices.

The IT knife nano is different from the other needle-type devices in that it does not have a jet function. In
the future, it is expected to have more functions as technology progresses and develops. We believe that the
IT knife nano is an indispensable device for colorectal ESD in terms of safety, reliability, and efficacy.

DECLARATIONS
Authors’ contributions
Data acquisition and writing manuscript: Takamaru H
Made substantial contributions to conception, data acquisition, and supervised: Saito Y

Availability of data and materials
Not applicable.

Financial support and sponsorship
This work was supported in part by the National Cancer Center Research and Development Fund (25-A-12,
28-K-1, and 29-A-13) to Saito Y.

Conflicts of interest
Saito Y received speaker’s fees from Olympus Medical Co., Tokyo, Japan. Takamaru H declared that there
are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.