2.5-mm articulated endoluminal forceps using a compliant mechanism

The Role of Specialized Instruments for Advanced Endoscopic Resections in Gastrointestinal Disease

INTRODUCTION

Advanced endoscopic therapy techniques have been developed and have created alternative treatment options to surgical therapy for several gastrointestinal diseases. This work will focus on new endoscopic tools for special indications of advanced endoscopic resections (ER), especially endoscopic submucosal dissection (ESD), which were developed in our institution. This paper aims to analyze these specialized instruments and identify their status.

METHODS

Initially, the technical process of ESD was analyzed, and the following limitations of the different endoscopic steps and the necessary manipulations were determined: the problem of traction-countertraction, the grasping force needed to pull on tissue, the instrument tip maneuverability, the limited angulation/triangulation, and the mobility of the scope and instruments. Five instruments developed by our team were used: the Endo-dissector, additional working channel system, external independent next-to-the-scope grasper, 3D overtube working station, and over-the-scope grasper. The instruments were used and applied according to their special functions in dry lab, experimental in vivo, and clinical conditions by the members of our team.

RESULTS

The Endo-dissector has a two-fold function: (1) grasping submucosal tissue with enough precision and strength to pull it off the surrounding mucosa and muscle, avoiding damage during energy application and (2) effectively dividing tissue using monopolar energy. The AWC system quickly fulfills the lack of a second working channel as needed to complete the endoscopic task on demand. The EINTS grasper can deliver a serious grasping force, which may be necessary for a traction-countertraction situation during endoscopic resection for lifting a larger specimen. The 3D overtube multifunctional platform provides surgical-like work with bimanual-operated instruments at the tip of the scope, which allows for a coordinated approach during lesion treatment. The OTSG is a grasping tool with very special features for cleaning cavities with debris.

CONCLUSIONS

The research and development of instruments with special features can solve unmet needs in advanced endoscopic procedures. The latter may help to increase indications for the endoscopic resections of gut lesions in the future.

Thermal damage map prediction during irreversible electroporation with U-Net

Recent developments in cancer treatment with irreversible electroporation (IRE) have led to a renewed interest in developing a treatment planning system based on Deep-Learning methods. This paper will give an account of U-Net, as a Deep-Learning architecture usage for predicting thermal damage area during IRE. In this study, an irregular shape of the liver tumor with MIMICS and 3-Matic software was created from Magnetic Resonance Imaging (MRI) images. To create electric field distribution and thermal damage maps in IRE, COMSOL Multiphysics 5.3 finite element analysis was performed. It was decided to use the pair needle, single bipolar, and multi-tine electrodes with different geometrical parameters as electrodes. The U-Net was designed as a Deep-Learning network to train and predict the thermal damage area from electric field distribution in the IRE. The average DICE coefficient and accuracy of trained U-Net for predicting thermal damage area on test data sets were 0.96 and 0.98, respectively, for the dataset consisting of all electrode type electric field intensity images. This is the first time that U-Net has been used to predict thermal damage area. The results of this research support the idea that the U-Net can be used for predicting thermal damage areas during IRE as a treatment planning system.