Characteristics and uses of IT knife nano

IT knife nano® (Olympus Medical Co., Tokyo, Japan) is a knife device specialized for esophageal and colorectal endoscopic submucosal dissection (ESD). The IT knife nano has a smaller insulated tip than that of the IT knife 2, making it easier to handle the submucosal layer in the colorectum. The disk behind the insulated tip is also smaller to reduce thermal damage to the muscle layer. Furthermore, the IT knife nano is considered to have more power for incision because the IT knife nano has a large amount of electric current at the blade compared to other devices. Therefore, the IT knife nano can resect a larger amount of submucosal layer tissue at once, enabling a faster and more reliable detachment of the submucosal dissection as well as a circumferential mucosal incision. When performing submucosal dissection using an IT knife nano, the knife should be moved from the outside to the inside. While in a difficult situation, moving the knife gradually from the center (inside) to the outside can help perform a safe colorectal ESD. The IT knife nano is considered an option for difficult situations, such as lesions with severe fibrosis, or when rapid submucosal dissection is required. We herein provided technical aspects of the IT knife nano in detail and compared it with other needle-type devices