7091EASY AND SURE NEW TECHNIQUE TO MARK THE RESECTINGAREA OF COLON ON LAPAROSCOPIC SURGERY.Yasushi Oda, Takahiro Fujii, Ryukichi Akashi, Masaya Moriyasu, KatsuroSagara, Kumamoto Regional Med Ctr, Kumamoto, Japan; National CancerCtr, Tokyo, Japan.Purpose With spread of laparoscopic surgery for colon, more reliable way tofind the lesion from the serosa side during the surgery became more impor-tant. We developed new technique to mark the lesion. Marking was usual-ly done by injecting Indian ink with needle through the fiberscope frommucosal side of colon in Japan. But injection not a few failed to limit theink within the wall of colon. We tried to apply the EMR technique to themarking. Methods The principle is first to inject 2-3ml of saline into sub-mucosal layer with needle device, to make submucosal upheaval of about1cm and continuously to change saline to ink and inject it. Then we couldlimit the ink firmly. We modified these methods to find the best way inrespects of ink concentration, amount, location and period until thesurgery. Baseline conditions were 11% Indian ink, 0.5ml in amount, every2 points at both oral and anal side at a distance of 5cm from tumor mar-gin and 2days before the surgery. Alternatives were 5%, 0.2ml, 3cm fromthe margin, respectively. The better conditions were examined. Subjectswere 30cases in total, 5cases each in baseline and alternative of concen-tration, amount and distance. Injection was performed at 2days beforesurgery in 18cases, 3days before in 4cases and 7days before in 8cases.Results In 30cases, there were no leak of ink into peritoneal cavity, but20%(4/20) on ordinary methods in the past. In our new technique, 5% inconcentration was easier to inject smoothly. 0.2ml in amount was better onthe points of size of staining on surgery. There was no difference in localspread of ink among periods from marking until the surgery. ConclusionsThe principle and details of our new technique for marking on laparoscop-ic surgery is easy and sure method.

7092IMPROVEMENT OF SNARE FOR SURE AND SAFE ENDSCOPICMUCOSAL RESECTION (EMR) OF COLON TUMORS.Yasushi Oda, Ryuukichi Akashi, Katsuro Sagara, Kumamoto MedRegional Ctr, Kumamoto, Japan; Kumamoto Regional Med Ctr,Kumamoto, Japan.Backgrounds: Flat tumors in the colon and rectum has been recognizedand found in practical colonoscopy examinations in the world. To suchmucosal tumors, EMR technique has spread the adaptation of endocopictherapy. But the snares for EMR on sales have not been satisfied becausethe sliding at side of the snare has been seen sometimes during graspingwhich may make incomplete resection. So we improvedsnare for more sureand safe endocopic therapy. Methods: The snare was modifiedbased on theSD-17U-1 (Olympus company, Japan) with the cooperationof Olympus. SD-17U-1 was based because of size of the snare ring and hardness is ade-quateto prevent perforation and to make easier to grasp the tumor. But thedemerit of this snare is also the slide at the side when grasping the tumor.Small needles inside the snare actually are not helpfulin some cases. Threereuse types were made as A, B and C according to the difference of locationof the needles inside the snare ring mainly. Five each type was made. Onesnare was used to 3 flat lesions. Preoperative conditions variables wereevaluated as follows; size of the lesion, the degreeof swelling after salineinjection and location of the lesion in the field of endoscopic vision.Endpoint variableswere the degreeof easinesswhen grasping, the degreeofeasinesswhen cuttingthe lesion and complete resection or not histological-ly. From these results, the location of the needles was finally improved asD type. After the pilot experience, D type was compared with SD-17U-1 inthe open-randomized study design. Each eighteen flat lesions were exam-ined. Results: The best number of the inside needles was four and the bestlocation was at maximum width and its oral side. Ideal cuttingcurrencywas 40 W in blend mode in PSD-20, Olympus. The sharpness of the needleswas also idealized. Even in small size study, D types compared with thebase type were obviously better to the flat lesions more than 15mm in size.Conclusions: We encouraged to perform multi-center study to prove thisnew snare to help complete resection much easier.

7093THE USEFULNESS OF COLONOVIDEOSCOPE WITH VARIABLESTIFFNESS.Tatsuya Odori, Hidemi Goto, Tomiyasu Arisawa, Yasumasa Niwa, NaokiOhmiya, Tetuo Hayakawa, NAGOYA Univ, Nagoya, Japan.Background and study aim:This study was designed to asses the useful-ness of colonovideoscope with variable stiffness, compared with conven-tional videoscopes. Patients and Methods:The first prototype XCF-QAY1and the latter prototype XCF-Q240AI used in this study can be varied to 4stages of stiffness modes of tube insertion during examination. (1) floppymode is the same stiffness of PCF, (2)normal mode is the same stiffness ofconventional videoscopes, (3) half of stiffness between 2 and 4, (4) stiffmode is same stiffness of CF-200HI that is a little flexible than slidingtube. We especially made attention that variable stiffness could be usedonly after colonoscope straightend and not be used during loop formation.In the 352 consecutive colonoscopy examinations perfomed using thesescopes, the following data were recorded: the time for intubation to thececum, frequency of change in the patient’s posture, frequency of abdomi-nal manipulation attempt, pain score and patient profiles(age, sex, pastabdominal and pelvic surgical history, obesity). The mode of the stiffness ofthe insertion tube and the examiner’s impression score were recorded onlyin cases using the above mentioned scopes. Results:There was no signifi-cant difference among each colonoscope case in the pain score. Total colo-noscopy rate was 97.4%. The frequency of varying stiffness sites in thecolon as follows:descending colon(56.8%), transverse colon (33.3%), sigmoidcolon (7.6%) and ascending colon(2.3%). A significant difference in themean time for intubation to the cecum between XCF-Q240AI and conven-tional scopes was observed. Moreover, there were significant differences inthe time of abdominal manipulation attempt and change in the patient’sposture between conventional scopes and the new scopes.Conclusions:These results suggest that only one scope, especially XCF-Q240AI is needed for any colonic examination by any examiner.

7094FLEXIBLE ENDOSCOPE STAND—MILLENNIUM ACCESSORYOR NECESSITY? Elizabeth Rajan, Lori J. Herman, Warren N. Lenz, Christopher J. Gostout,Apollo Group, Mayo Clin, Rochester, MN.Therapeutic endoscopy in the new millennium will undoubtedly be morecomplex and challenging. New techniques may require simultaneous use ofmultiple endoscopic accessories. This would necessitate a device capable ofstabilizing a flexible endoscope and freeing up the endoscopists’ hands.Aim: To design a flexible endoscope stand that would secure an endoscopein any given position. Method: A rigid post and clamp device was fashionedand fitted onto a stabilizing Plexiglas plate which is placed under thepatient. A screw-type clamp contains the endoscope control arm. Positionof the endoscope control arm can be adjusted by raising and lowering theclamping mechanism. The clamping mechanism provides 360˚ rotationwith the ability to fix the endoscope control arm (handle) in any desiredposition. The device was then assessed during complex therapeutic proce-dures using dual channel endoscopies with simultaneous use of two acces-sories. Results: The stand successfully freed up the endoscopists’ hands foraccessory manipulation and other activities requiring interruption of theendoscopic procedure. It provided this function while at the same timemaintaining the position of the endoscope accurately and safely within thepatient. The stand proved to be portable, durable, easy to disinfect andrequired only the weight of the patient for stability. Device function waslimited when excess rotational torque of the endoscope insertion tube wasneeded. The cost of the stand materials was $270. Conclusion: 1) The flex-ible endoscope stand meets an evolving need to facilitate complex endo-scopic procedures that require the simultaneous use of both hands of theendoscopist in order to control two accessories or the secondary use of amini-scope. 2) The stand can also be employed during an interruption of aprocedure to attend to patient needs. 3) Furthermore, the use of such adevice may also have the added benefit of reducing the growing risk ofrepetitive use syndrome during lengthy procedures. (The Apollo Group:Sydney Chung, Peter Cotton, Christopher Gostout, Robert Hawes, AnthonyKalloo, Pankaj Pasricha, Thadeus Trus)

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