Special Interview with Dr. Yoshikazu Hayashi the First Prize Winner of the 2023 Best Paper Award

On August 5, 2024, the Editorial Office of Mini-invasive Surgery (MIS) had the privilege of interviewing Dr. Yoshikazu Hayashi, the esteemed First Prize Winner of the 2023 Best Paper Award. Dr. Hayashi was recognized for his article “The pocket-creation method of endoscopic submucosal dissection”, in which he is the first author.

In this interview, Dr. Hayashi shared profound insights into the pocket-creation method (PCM), a technique that has gained significant attention for its effectiveness in endoscopic submucosal dissection (ESD). The discussion covered various aspects of PCM, including its advantages in different anatomical contexts, its potential evolution with advancements in traction techniques, and its applicability across diverse patient populations and tumor types.

Here are details of the interview:

Q1: Your article mentions that PCM is recommended for both colorectal and upper-gastrointestinal ESD. Could you elaborate on the specific advantages of PCM in these different anatomical contexts?

A1: In the confined space of the submucosal pocket, the conical cap stretches the submucosal tissue, even if it is fibrotic, enabling the determination of a dissection line within our field of vision. This visual identification of the dissection line is effective in the colorectum, stomach, duodenum, and esophagus simply by creating a limited-space pocket. However, when performing pocket-creation method (PCM) for esophageal lesions, the approach will eventually become tunneling, as the dissection tends to proceed straight rather than laterally.

Q2: How do you see the role of PCM evolving in the next five to ten years, especially with the advancement of traction techniques? Are there any specific areas of research you believe need further exploration?

A2: Traction devices are game changers for endoscopic submucosal dissection (ESD). Although traction devices can only provide traction and not countertraction, the conical cap used in the pocket-creation method (PCM) can produce both traction and countertraction, particularly in narrow spaces, effectively stretching even fibrotic submucosa. Consequently, PCM with the conical cap will remain useful even as traction devices become more common.

Q3: Are there any particular patient populations or types of gastrointestinal tumors that benefit most from the PCM approach? Could you discuss any clinical scenarios where PCM might be preferred over other techniques?

A3: The pocket-creation method (PCM) is effective for lower gastrointestinal (GI) endoscopic submucosal dissection (ESD) regardless of tumor morphology. We have also demonstrated that PCM is useful for duodenal tumors and gastric tumors along the lesser curvature. However, most gastric ESD cases, except for those involving lesser curvature tumors, are treated using other ESD techniques. Additionally, PCM should be selected for any gastrointestinal tumors with severe submucosal fibrosis, as it excels in managing fibrotic tissue.

Q4: Could you discuss any ongoing or upcoming research projects you are involved in related to PCM or ESD? How might these projects contribute to the field and potentially benefit patients?

A4: We are discussing the usefulness of drainage tube techniques for endoscopic submucosal dissection (ESD). These techniques may facilitate not only the standard pocket-creation method (PCM) but also saline-immersion ESD and water-pressure-method ESD.

Q5: How do you see the field of minimally invasive surgery evolving with innovations like PCM? What future trends or developments do you anticipate will shape the landscape of gastrointestinal tumor treatment?

A5: I cannot predict future endoscopic innovations. In my opinion, any endoscopic treatment should strive not only for effectiveness but also for simplicity, ease of use, cost benefits, and the ability to be implemented in routine situations without the need for complex, dedicated devices.

Q6: What do you think of the experience of contributing to Mini-invasive Surgery? Any suggestions for our journal?

A6: I would like to express my gratitude for the opportunity to introduce the details of the pocket-creation method (PCM). I suggest that it would be beneficial for everyone if your journal provided opportunities for inventors who have not yet gathered enough objective data to prove the usefulness of their innovations.

Authors:

Yoshikazu Hayashi, Yoshimasa Miura, Alan Kawarai Lefor, Hironori Yamamoto

Corresponding author:

Prof. Hironori Yamamoto

Chairman and Professor of Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan

Prof. Hironori Yamamoto was born and raised in Kochi, Japan. He graduated from Jichi Medical University in 1984, subsequently completing post-graduate clinical training in the Kochi Central Hospital from 1984 – 1986. He then pursued further training abroad at the Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota and Department of Medicine, University of Texas Southwestern Medical Centre, Dallas, Texas. He returned to Japan to join the Department of Medicine, Division of Gastroenterology, Jichi Medical University in 1995.

He is the inventor of double-balloon endoscopy and a pioneer of ESD. His ESD technique, PCM, is considered a form of third space endoscopy. With PCM, a stable condition in submucosal dissection is obtained and several challenging situations can be overcome.

Awards and Honors:

Once again, the Editorial Office of MIS extends heartfelt congratulations to Prof. Michel Gagner!

Editor: Irene Liu
Language Editor: Emma Chen
Production Editor: Yan Zhang
Respectfully submitted by the Editorial Office of Mini-invasive Surgery