# Enhancing efficiency in ESD: a comparative analysis of ERBE VIO3 and 300d electrosurgical units

## TL;DR

This study compares two electrosurgical units during endoscopic submucosal dissection, finding that one reduces the need for coagulation graspers.

## Contribution

The study introduces a direct comparison of ERBE VIO3 and 300d in ESD procedures, focusing on coagulation grasper usage.

## Key findings

- VIO3 significantly reduced overall coagulation grasper use compared to VIO 300d.
- VIO3 showed fewer coagulation grasper uses for arterial bleeding and per cm² of lesion.
- VIO3 use led to a non-significant trend toward increased procedural efficiency.

## Abstract

Electrosurgical units (ESUs) are essential for tissue dissection hemostasis during ESD. The ERBE VIO 3, enables rapid setting changes, facilitating the swift application of vessel sealing current. Additionally, features such as PreciseSect mode allow dynamic modulation frequency adjustment, making it suitable for submucosal dissection and vessel management. Our comparison of the ERBE VIO3 and 300d aims to assess whether these functionalities enhance the ESD experience.

From 2021 to 2024, 88 patients undergoing ESD for colorectal lesions were identified from a prospectively maintained database. Lesions were categorized based on the ESU utilized.

Eighty-eight procedures were identified. Forty-four (50.0%) procedures were performed using VIO 3 and 44 (50.0%) using VIO 300d. 40 (45.5%) lesions were colonic and 48 (54.5%) rectal. Median lesion diameter was 4.5 cm. Lesions in the VIO3 group were significantly larger (P = 0.027). All ESDs were completed en bloc. Use of the VIO3 resulted in a significantly fewer uses of coagulation graspers overall (28 vs 23, P < 0.001), fewer uses of coagulation graspers for arterial bleeding (1 vs 2, P < 0.001), fewer uses of coagulation graspers per cm2 (0.17 vs 0.58, P < 0.001), and fewer uses of coagulation graspers per minute (0.011 vs 0.066, P < 0.001). This led to a non-significant trend in increased efficiency with use of the VIO3 (4.6 vs 5.1 min/cm2, P = 0.667).

The VIO 3 significantly decreased reliance on coagulation graspers, particularly in addressing arterial bleeding. This holds the potential to enhance procedural efficiency, reduce bleeding, and lower costs associated with coagulation graspers usage.