New breakthrough in minimally invasive technology, endoscopic “tunnel warfare” Recently, the Gastroenterology Endoscopy Center of the First Affiliated Hospital of SUDA successfully performed tunneling endoscopic submucosal tumor excision (TT-ESE) for 8 patients with upper gastrointestinal tumors using the latest endoscopic minimally invasive technology. At present, only three hospitals in the world are performing this technique. Based on the successful performance of 6 cases of transoral endoscopic esophageal myotomy (POEM) for cardia achalasia, our minimally invasive gastrointestinal endoscopy team was the first in the world to explore the clinical application of the tunneling endoscopy technique and named the technique TT-ESE after combining the frontiers of the discipline and our own practice. Mr. Yu, 31 years old, came to the hospital with dysphagia, and ultrasound gastroscopy revealed The traditional treatment was surgical resection, but the patient wanted a minimally invasive treatment without gastric incision and quick recovery, considering his young age. After receiving the patient, Dr. Li Rui of the Department of Gastroenterology carefully studied the patient’s condition and imaging data, and finally decided to use the most advanced international tunneling endoscopic technology to perform minimally invasive endoscopic treatment on the patient, and carefully designed the endoscopic surgery plan. The minimally invasive endoscopic treatment team, consisting of doctors Li Rui and Shi Dongtao, nurses Chen Xia and Wang Xiya from the Department of Gastroenterology, with the collaboration of the Department of Anesthesiology, used the latest minimally invasive resection instruments and methods to open a window in the superficial layer of the esophagus (mucosa) about 5 cm above the subcardia fundic tumor, and then opened a submucosal “tunnel” along the interstitial layer of the esophagus (submucosa) “The tumor was reached directly. And the tumor was carefully peeled off under direct endoscopic view. After complete removal of the tumor, the tumor was removed through the “tunnel” and the tunnel opening was closed with a metal clip. The TT-ESE procedure was performed in only one hour. On the second day after the operation, the patient ate liquid food, and on the third day, he ate a meal and was discharged from the hospital on the fourth day. The patient is now recovering well and her symptoms have completely improved. Endoscopic resection of digestive tract tumors has the advantages of minimally invasive, fast recovery and preservation of the integrity of the digestive tract compared with traditional surgical procedures. The TT-ESE technique is equivalent to a “tunnel war” by creating a submucosal tunnel to excavate the tumor completely. Even if the tumor is perforated after excavation, as long as the “tunnel opening” can be clamped under the endoscope, the operation will be safe in the end. The tunneling endoscopy technique was invented by Professor Haruyo Inoue of Showa University in Japan, and was initially applied to POEM surgery for cardia incontinence. At the International Symposium on New Endoscopic Resection Techniques held in Shanghai in April this year, the endoscopic treatment team of Zhongshan Hospital reported the world’s first tunneling endoscopic technique to remove submucosal tumors. With the support of hospital and departmental leaders, our gastrointestinal endoscopy minimally invasive treatment team kept up with the frontier of world endoscopic technology and combined with their own practice to successfully establish the TT-ESE surgical protocol. In the past two months, a total of 8 patients with upper gastrointestinal smooth muscle tumors, mesenchymal tumors and lipomas have been successfully operated on. The development of this technique marks a new level of minimally invasive gastrointestinal endoscopic treatment technology in our hospital.