This is the first report to show the utility and feasibility of removing surgical staples during endoscopic submucosal dissection (ESD) for residual gastric cancer in the remnant stomach. The surgical staples were removed using the Dual Knife, and we electrified the knife in EndoCut mode while pulling out the staple so that it could be removed immediately.
ESD for residual gastric cancer in the suture line poses some specific technical difficulties due to the limited working space, severe fibrosis in the suture line or anastomosis, and the presence of staples. Given that staples in the suture line pose a risk of perforation, most surgeons aim to dissect directly above the staples. However, a shallower dissection layer can damage the specimen and leave behind tumor remnants. On the other hand, dissecting below the staples also poses a risk of perforation. Moreover, dissection in the layer containing the staples results in a continuous flow of current through the staples, which increases the time required for the dissection. For these reasons, staples may need to be removed to expose the exfoliated layer during ESD. However, there are few reports on the safety and utility of removing surgical staples during ESD. We felt it was important to show a case describing the utility of removing surgical staples.
The result is that the current through the staple will result in an EndoCut effect on the tissue that is in contact with the staple, which will then release the staple if some tension is placed. This could have also been achieved by grasping the suture with coagulation forceps or any other knife (eg, hook knife) while applying EndoCut current.
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