Work-Related Musculoskeletal Injury Rates, Risk Factors, and Ergonomics in Different Endoscopic Specialties: A Review.

Endoscopy-related musculoskeletal injuries (ERIs) are frequent among gastrointestinal, pulmonary, nasal, and urologic endoscopists, impacting the healthcare system. The present review aims to compare the ERI rates, risk factors, and ergonomic recommendations in the different endoscopic fields. A review was conducted using PubMed and Cochrane Library for articles based on surveys and published until 10 January 2024. Demographic, work, and ERI data from 46 publications were included, covering 10,539 responders. The ERI incidence ranged between 14% and 97%, highlighting the need of intervention independent of the specialties. The neck, back, and shoulder were the most frequent ERI locations, while gender, age, years of experience, and procedure volume the most common risk factors. Ergonomic recommendations suggest concentrating on endoscope design changes, especially in gastrointestinal endoscopy, to increase the comfort, adaptability of the equipment in the operating room, and workflow/institutional policy changes. The inclusion of an ergonomic timeout guarantees the correct equipment positioning, the neutralisation of the endoscopist's posture, and an indirect break between procedures. Ergonomic training to increase awareness and best practice should be promoted, also using new technologies. Future research should concentrate on intervention and comparative studies to evaluate to which extent prevention measures and newly designed equipment could reduce ERI incidence.

A new 3D-printed overtube system for endoscopic submucosal dissection: first results of a randomized study in a porcine model.

BACKGROUND AND STUDY AIM: Endoscopic therapy of early malignant alterations can be difficult and cumbersome. Our research study group took advantage of new methods for rapid prototyping (i. e. 3D printing) to design and test an overtube system with two manipulator arms at the tip. Both arms can be steered independently from each other by a dedicated user platform. METHODS: This animal study involved a randomized evaluation of the new overtube device for endoscopic submucosal dissection (ESD) compared with a conventionally performed ESD. In total, 12 ESDs in six pigs were performed. Six ESDs were performed in the stomach and six in the colon. Size (in cm(2)) of resected specimens, the time needed to perform endoscopic resection, and adverse events were assessed. RESULTS: The overtube-assisted ESD was faster and therefore more effective than the conventional ESD technique (0.45 ±â€Š0.24 cm(2)/min vs. 0.22 ±â€Š0.11 cm(2)/min; P = 0.029). Only one adverse effect was recorded in the conventional group.  CONCLUSIONS: The overtube-assisted ESD was feasible in an animal model. ESD can be performed more quickly and potentially more effectively with the newly designed overtube device compared with the conventional ESD technique.

A new instrument for endoscopic submucosal dissection (with videos).

BACKGROUND: Although it is effective for treatment of early neoplasms, endoscopic submucosal dissection (ESD) can be technically demanding and time consuming. Furthermore, use of multiple instruments is often mandatory for performing various steps associated with the procedure. OBJECTIVE: To design, create, and evaluate a new instrument for ESD. DESIGN: Feasibility study by using an acute porcine model. SETTING: Center for preclinical research, university hospital. SUBJECTS: This study involved 6 female pigs. INTERVENTION: Gastric ESDs including circumferential incision and coagulation of bleeding vessels were performed by using a single device. Incision was done with the prototype instrument in a closed position by using cutting current. Submucosal dissection was performed by using an approach with 4 steps: (1) open forceps, (2) grasp submucosal fibers, (3) elevate and retract tip to avoid contact with muscle layer, (4) dissect fibers by using cutting current. Bleeding was terminated with the same instrument by grasping vessels and applying coagulation current. MAIN OUTCOME MEASUREMENTS: Overall feasibility and performance, time needed to achieve complete resection. RESULTS: The new instrument was useful for performing all single steps needed. Mean (± standard deviation [SD]) time needed for the whole procedure was 48.5 ± 9.9 minutes. Mean (± SD) time needed for incision and dissection was 37.8 ± 8.8 minutes. LIMITATIONS: Animal study, limited number. CONCLUSION: The new instrument has potential advantages in comparison with standard instruments used for ESD. Incision, dissection, and coagulation of vessels can be performed with a single instrument, and the technique of lifting submucosal fibers during dissection potentially decreases the risk of perforation. Comparison studies with larger gastric lesions treated with standard ESD techniques are needed.

Experimental validation of a tissue-joining implant providing flexible adaptation to the thickness of the stomach wall.

Endoscopy is gradually replacing open surgery in the gastrointestinal tract. Therefore, novel medical devices and instrumentation are required, such as flexible miniaturized mechanisms for tissue joining and manipulation. In this paper, an absorbable implant for the purpose of long-term tissue fixation is presented. An experimental validation of the implant design and functionality is introduced. The implant achieves tissue penetration and provides flexible adaptation according to the thickness of two stomach walls. This mechanism is easy as it is based on push-pull principle using unidirectional forces. The shape optimization of each implant part occurs by varying design-influencing factors. The load transmission on postmortem porcine tissue was measured in the frame of the experimental setup. The feasibility of the implant was tested, and the forces needed for the intended application quantified. The implant successfully achieves tissue penetration, load transmission, adjustment, and fixation. It is a new alternative to conventional tissue-joining mechanisms.