Potential concerns of the induction of ultrasonic cleaning include damage to the device, cost performance, protection from infection. This suggests ultrasonic cleaning has a higher ability to clean the debris and reduce cleaning time than the conventional method. In our pre‐study experiments, it took about 60–90 s for the conventional method and 30–40 s for ultrasonic cleaning (40 kHz) to achieve a cleaning score of 5 for almost all models. This is called the “cavitation effect,” which is stronger at lower frequencies and weaker at higher frequencies. These shock waves are also reported to be effective in disrupting bacterial cell membranes and reducing the number of bacteria. In ultrasonic cleaning, ultrasonic waves in the range of 20–100 kHz are irradiated into the liquid, and the resulting shock waves generated by the cavitation phenomenon peel off foreign substances from the object. Furthermore, the principle of such debris adhesion is considered to be the same for devices other than the IT knife‐2, and the combined ultrasonic cleaning method is expected to be effective in removing firm debris for other devices. The combined ultrasonic cleaning method was able to more effectively remove firm debris adhering to the IT knife‐2 than the conventional cleaning method. In the present study, ultrasonic cleaning was introduced in addition to conventional physical scrubbing. To the best of our knowledge, this study was the first ex‐vivo experimental study of an ultrasonic cleaning machine for an endoscopic instrument. This study protocol adhered to the principles of the Declaration of Helsinki. These methods are in accordance with the Clinical Trials Act and have been reviewed and approved by the Research Ethics Review Committee (Case No: 201911‐02). An actual example of ultrasonic cleaning is shown in the Supporting Information video. The USC‐1 ultrasonic cleaner (AS ONE Co., Osaka, Japan) with a frequency of 40 kHz and a cleaning solution made of RO pure water were used in this study. In Group B, the knife was placed in the ultrasonic cleaner for 10 s (Figure 2c), and then the tip electrode was scrubbed with gauze soaked in saline solution for 20 s. In Group A, the tip electrode of the knife was scrubbed with saline‐soaked gauze for 30 s. Based on our experience that the time available for the device cleaning during ESD was approximately 30 s at a time, the cleaning time was set to 30 s for both groups in this study. The knives in Group A were cleaned using the conventional scrubbing method (conventional cleaning method), while those in Group B were cleaned using a combined method of scrubbing and ultrasonic cleaning (combined ultrasonic cleaning method). The prepared 40 knives with debris were randomly assigned to two groups (Groups A and B). Thus, in order to clarify whether ultrasonic cleaning is also effective in removing the debris on ESD knives, a comparative study was conducted on the insulation‐tipped diathermic (IT) knife‐2 (Olympus Co., Tokyo, Japan). Ultrasonic cleaning has long been used for accessories, eyeglasses, industrial equipment, and reportedly in recent years, for medical devices such as dental implants. For these reasons, an easy and efficient cleaning method is required. Moreover, there is a risk of damaging the tip by rubbing too hard. However, it is exceedingly difficult to remove the debris quickly and sufficiently using this method, and the residue is often left behind. In many facilities, the debris is usually removed by scrubbing the tip of the knife with gauze soaked in saline or pronase. Therefore, the adherent debris needs to be removed frequently during the procedure, and the improvement of the debris removal technology is one of the important issues for safe and efficient ESD. Which suppresses the current flow to the tip, resulting in its reduced incision and coagulation capabilities. In recent years, endoscopic submucosal dissection (ESD) has been performed to treat early‐stage gastrointestinal cancer.ĭuring ESD, carbonized clots and tissue (debris) tend to adhere to the tip of the ESD knife,
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