Presentation Information
[SY8-5]Dual-operator Endoscopic Tandem Surgery (DuETs) for large colorectal lesions: comparison with single-operator ESD
*Takuma Okamura1, Tomonari Ikeda2, Tatsuki Ichikawa2, Toshimitsu Miyaaki1 (1. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Japan, 2. Department of Gastroenterology, Nagasaki Harbor Medical Center)
**Background:** Large colorectal lesions remain challenging for endoscopic submucosal dissection (ESD) because poor visualization, insufficient traction, and bleeding may prolong the procedure. We developed Dual-operator Endoscopic Tandem Surgery (DuETs), in which two therapeutic endoscopes are used simultaneously: the primary operator performs dissection while the assistant provides traction, suction, hemostasis, insufflation/deflation control, and injection.
**Methods:** We retrospectively reviewed colorectal ESD for lesions ≥20 mm from January 2020 to April 2026. The primary analysis included expert-performed cases after DuETs introduction in January 2024 and compared DuETs with single-operator ESD. Cases discontinued because of suspected deep invasion, appendiceal involvement, diverticular extension, or anal canal involvement were excluded. The primary outcome was resection speed; secondary outcomes were procedure time, en bloc/R0 resection, and adverse events. A subgroup analysis was performed for lesions ≥40 mm.
**Results:** The primary analysis included 60 DuETs lesions and 37 single-operator ESD lesions. Median lesion size was larger with DuETs (32.5 vs 24.0 mm), whereas procedure time was not prolonged (30.5 vs 37.0 min). Resection speed was higher with DuETs (35.97 vs 24.98 mm²/min). En bloc resection was achieved in all cases, and R0 resection rates were 100% and 94.1%. Intraoperative adverse events occurred in 2 vs 1 cases, and postoperative adverse events in 1 vs 0 cases. In lesions ≥40 mm, DuETs shortened procedure time (62.0 vs 85.0 min) and increased resection speed (40.59 vs 25.75 mm²/min).
**Conclusions:** DuETs improved resection efficiency without compromising safety. As a dual-operator endoluminal platform, DuETs may contribute to difficult colorectal ESD.
**Methods:** We retrospectively reviewed colorectal ESD for lesions ≥20 mm from January 2020 to April 2026. The primary analysis included expert-performed cases after DuETs introduction in January 2024 and compared DuETs with single-operator ESD. Cases discontinued because of suspected deep invasion, appendiceal involvement, diverticular extension, or anal canal involvement were excluded. The primary outcome was resection speed; secondary outcomes were procedure time, en bloc/R0 resection, and adverse events. A subgroup analysis was performed for lesions ≥40 mm.
**Results:** The primary analysis included 60 DuETs lesions and 37 single-operator ESD lesions. Median lesion size was larger with DuETs (32.5 vs 24.0 mm), whereas procedure time was not prolonged (30.5 vs 37.0 min). Resection speed was higher with DuETs (35.97 vs 24.98 mm²/min). En bloc resection was achieved in all cases, and R0 resection rates were 100% and 94.1%. Intraoperative adverse events occurred in 2 vs 1 cases, and postoperative adverse events in 1 vs 0 cases. In lesions ≥40 mm, DuETs shortened procedure time (62.0 vs 85.0 min) and increased resection speed (40.59 vs 25.75 mm²/min).
**Conclusions:** DuETs improved resection efficiency without compromising safety. As a dual-operator endoluminal platform, DuETs may contribute to difficult colorectal ESD.