Surgical Endoscopy

, Volume 27, Issue 11, pp 4130–4135 | Cite as

Endoluminal surgical triangulation: overcoming challenges of colonic endoscopic submucosal dissections using a novel flexible endoscopic surgical platform: feasibility study in a porcine model

  • Michele Diana
  • Hyunsoo Chung
  • Keng-Hao Liu
  • Bernard Dallemagne
  • Nicolas Demartines
  • Didier Mutter
  • Jacques Marescaux



Colonic endoscopic submucosal dissection (ESD) is challenging as a result of the limited ability of conventional endoscopic instruments to achieve traction and exposure. The aim of this study was to evaluate the feasibility of colonic ESD in a porcine model using a novel endoscopic surgical platform, the Anubiscope (Karl Storz, Tüttlingen, Germany), equipped with two working channels for surgical instruments with four degrees of freedom offering surgical triangulation.


Nine ESDs were performed by a surgeon without any ESD experience in three swine, at 25, 15, and 10 cm above the anal verge with the Anubiscope. Sixteen ESDs were performed by an experienced endoscopist in five swine using conventional endoscopic instruments. Major ESD steps included the following for both groups: scoring the area, submucosal injection of glycerol, precut, and submucosal dissection. Outcomes measured were as follows: dissection time and speed, specimen size, en bloc dissection, and complications.


No perforations occurred in the Anubis group, while there were eight perforations (50 %) in the conventional group (p = 0.02). Complete and en bloc dissections were achieved in all cases in the Anubis group. Mean dissection time for completed cases was statistically significantly shorter in the Anubis group (32.3 ± 16.1 vs. 55.87 ± 7.66 min; p = 0.0019). Mean specimen size was higher in the conventional group (1321 ± 230 vs. 927.77 ± 229.96 mm2; p = 0.003), but mean dissection speed was similar (35.95 ± 18.93 vs. 23.98 ± 5.02 mm2/min in the Anubis and conventional groups, respectively; p = 0.1).


Colonic ESDs were feasible in pig models with the Anubiscope. This surgical endoscopic platform is promising for endoluminal surgical procedures such as ESD, as it is user-friendly, effective, and safe.


Anubiscope Colonic ESD Endoscopic submucosal dissection (ESD) Surgical endoscopic platform 



IRCAD-IHU Institutes are recipients of grants from Karl Storz Endoscopes, Tüttlingen, Germany; Covidien, Mansfield, MA, USA; and Siemens AG Healthcare, Munich, Germany. The authors acknowledge the European Funding for Regional Development (FEDER) and the Region of Alsace for supporting the ISIS project. The authors are grateful to Guy Temporal, Camille Fischer, and Christopher Burel for their valuable assistance.


Michele Diana, Hyunsoo Chung, Keng-Hao Liu, Bernard Dallemagne, Nicolas Demartines, Didier Mutter, and Jacques Marescaux have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Michele Diana
    • 1
    • 2
  • Hyunsoo Chung
    • 1
  • Keng-Hao Liu
    • 1
  • Bernard Dallemagne
    • 1
  • Nicolas Demartines
    • 2
  • Didier Mutter
    • 1
  • Jacques Marescaux
    • 1
  1. 1.Department of General, Digestive and Endocrine Surgery, IRCAD-IHUUniversity of StrasbourgStrasbourgFrance
  2. 2.Department of Visceral Surgery, CHUVUniversity Hospital of LausanneLausanneSwitzerland

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