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Nakamura et al. Mini-invasive Surg 2022;6:50 https://dx.doi.org/10.20517/2574-1225.2022.38 Page 7 of 20

Table 1. ESD stages and electrosurgical settings (VIO 300D, Erbe) in our facility
Knife Marking Mucosal incision Submucosal dissection Hemostasis
Needle-type knife: dual · Forced COAG, · EndoCut I, E2, D3, I3 · Forced COAG, E2, 50 W · Forced COAG, E2, 50
knife, Flush knife, etc. E2, 25 W · Swift COAG, E2, 50 W W (Minor bleeding)
· Soft COAG, · EndoCut I, E2, D3, I3
E4, 40 W
Bended-tip needle knife · Forced COAG, · EndoCut I, E2, D3, I3 · Forced COAG, E2, 50 W · Spray COAG, E2, 40-
type: hook knife E2, 20 W · Spray COAG, E2, 40 W 60 W
· Soft COAG, (Minor bleeding)
E4, 40 W
Partially insulated-type · EndoCut I, E2, D3, I3 · Swift COAG, E3, 80 W · Swift COAG, E3, 80 W
knife: IT-knife 2, etc.
· Forced COAG, E3, 50 W · Forced COAG, E3
· EndoCut I, E2, D3, I3 (Minor bleeding)
Scissor type: clutch · Forced COAG, · EndoCut Q, E1, D2, I1 (Coagulation · EndoCut Q, E1, D2, I1 (Coagulation · Soft COAG, E4, 80W
cutter, SB knife E3, 20 W before cutting: soft COAG, E4, before cutting: soft COAG, E4,
80W) 80W)
Hemostatic forceps: · Soft COAG, E5, 90W
coagulasper, etc.
D: Duration; E: effect; I: interval.

Table 2. ESD stages and electrosurgical settings (VIO 3, Erbe) in our facility
Mucosal
Knife Marking Submucosal dissection Hemostasis
incision
Needle-type knife: dual knife, · Forced COAG, E · EndoCUT I, E1, · Forced COAG, E7.0 · Forced COAG, E6.5 (Minor
flush knife, etc. 0.7 D3, I3 · EndoCUT I, E1, D3, I3 bleeding)
· Soft COAG, E4
Bended-tip needle knife type: · Forced COAG, · EndoCUT I, E1, · Spray COAG E4.7 · Forced COAG, E6.5 (Minor
hook knife Effect 4.5 D3, I3 · Forced COAG, Eeffect 7 bleeding)
· Soft COAG, E5 · DRY CUT, E2.5
Partially insulated-type knife: · EndoCUT I, E2, · Swift COAG, Effect 6.0 · Swift COAG, Effect 6.0
IT-knife 2, etc. D3, I3 · EndoCUT I, E2, D3, I3 (Submucosa (Minor bleeding)
without vessels)
Hemostatic forceps: · Soft COAG, Effect 6.0
coagulasper, etc.

Table 3. ESD stages and electrosurgical settings (ESG 300, Olympus) in our facility
Submucosal
Knife Marking Mucosal incision Hemostasis
dissection
Needle-type knife: dual knife, · Forced COAG, Effect · Pulse CUT Fast, E2, · Forced COAG, E3, 50 W · Forced COAG, E3, 50 W
Flush knife, etc. 2, 40 W 40-100 W · Pulse CUT Fast, E2, 40- (Minor bleeding)
· Soft COAG, Effect 3, 100 W
80 W
Partially insulated-type knife: · Pulse CUT Fast, E3, · Power COAG, E3, 80- · Power COAG, E3, 80-120 W
hook knife 100 W 120 W (Minor bleeding)
· Pulse CUT Fast, Effect 3,
100 W
Hemostatic forceps: · Soft COAG, Effect 3, 100 W
Coagulasper, etc.

open the incised mucosal line [Figure 5B]. If the mucosal incision starts from the anti-gravity side, the
lesion loses mucosal tension, shifts to the gravity side, and makes the mucosal incision on the gravity side
difficult [Figure 5C]. A lesion on the gravity side presents the most difficult dissection position because
spontaneous flapping of the dissected specimen by gravity cannot be achieved, and the fluid in the stomach