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Page 4 of 20 Nakamura et al. Mini-invasive Surg 2022;6:50 https://dx.doi.org/10.20517/2574-1225.2022.38

Figure 1. Endo-knives for endoscopic submucosal dissection (ESD): (A) needle-type knife (Dual Knife J. Olympus, Co., Ltd.); (B) partially
insulated-type knife (IT Knife2. Olympus, Co., Ltd.); and (C) scissor-type knife (SB Knife Jr. Sumitomo Bakelite, Co., Ltd.). The image in
(C) is used with permission from Sumitomo Bakelite, Co., Ltd.

Figure 2. Direction of movement for mucosal incision and submucosal dissection with a needle-type knife.

Because the axes of the scope tip and knife are aligned, a unique scope position is required to make the
scope tip parallel to the target. The blade is 4 mm long, so the amount of tissue that can be dissected
simultaneously is large. Examples of partially insulated-type devices are the insulated-tip (IT) knife 2
(Olympus, Co., Ltd.), SAFE knife (Fujifilm, Co., Ltd.), and Mucosectom (Pentax, Co., Ltd.).

Scissor-type knife
The scissor-type knife has monopolar scissor blades covered with an insulated coating element on the
external side and can be rotated 360°. To use the scissor-type knife, the target tissue is first grasped, slightly
pulled up, and an electrical current is applied. As the tissue is grasped by the device before cutting, the
device is stabilized; hence, unintended tissue dissection is minimized. Furthermore, vessels in the dissecting
tissue are also grasped and prophylactically cauterized; therefore, bleeding during submucosal dissection is
rare. One disadvantage of the scissor-type knife is the prerequisite for a trained assistant as the assistant is