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Kuwai et al. Mini-invasive Surg 2022;6:16 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.122

Review Open Access

SB Knife Jr: characteristics and tips on how to use

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Toshio Kuwai , Yuzuru Tamaru , Ryusaku Kusunoki , Sauid Ishaq 2
1
Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-
0023, Japan.
2
Gastroenterology Department, Dudley Group Hospitals, Birmingham City University, Birmingham DY1 2HQ, United Kingdom.
Correspondence to: Dr. Toshio Kuwai, Department of Gastroenterology, National Hospital Organization Kure Medical Center
and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure 737-0023, Japan. E-mail: Kuwai.toshio.ur@mail.hosp.go.jp
How to cite this article: Kuwai T, Tamaru Y, Kusunoki R, Ishaq S. SB Knife Jr: characteristics and tips on how to use. Mini-invasive
Surg 2022;6:16. https://dx.doi.org/10.20517/2574-1225.2021.122

Received: 29 Oct 2021 First Decision: 12 Jan 2022 Revised: 26 Jan 2022 Accepted: 8 Feb 2022 Published: 12 Mar 2022
Academic Editor: Giulio Belli Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Widespread adoption of colorectal endoscopic submucosal dissection (ESD) in clinical practice is lagging despite
the peer evidence that it permits en bloc resection of large lesions that can be curative and facilitate pathological
staging, thereby improving management. Limited adoption of colorectal ESD is likely due to technical challenges
and a steep learning curve. Most conventional ESD devices are used without fixing the target, making them difficult
to maneuver and thus creating a potential risk of perforation. Comparatively, a scissor-type knife, such as the SB
Knife Jr, enables grasping of the target tissue, facilitating controlled dissection of tissue being held between the
blades. This potentially prevents unexpected muscular layer injury. Colorectal ESD with the SB Knife Jr does not
require complex endoscopic maneuvering or advanced skills for safe ESD. Since the incision and dissection
procedure using the SB Knife Jr is different from that of conventional ESD knives, familiarization with its features is
vital. In this review, we focus on the use of the SB Knife Jr for colorectal ESD. The basic colorectal ESD procedure
using the SB Knife Jr consists of grasping, pulling, and cutting. By repeating these steps, circumferential incision,
submucosal dissection, and hemostasis can be performed with a single device. For incision and dissection, a
circumferential mucosal incision is performed similar to “cutting paper”. Submucosal dissection is performed with
the image of “connecting the dots at the appropriate dissection depth”. The SB Knife Jr is useful as a secondary
device in challenging ESD procedures, and surgeons should master its use.

Keywords: Scissor-type knife, SB Knife Jr, endoscopic submucosal dissection, colorectal cancer

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
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