Here yesterday, we talked about precise sect. I want to just expand the knowledge of the precise sect. As we heard from Dr. Toyonaga, this VIA-3 new machine got so much smarter. The calculation, computation is so fast, 25 million per second. They are monitoring constantly what type of energy delivery is happening. The current compared to the voltage. It's adjusting continuously. The precise sect actually is described as a modulated frequency that creates dissection without the smoke and char. It effectively cuts and at the same time coagulates. It sounds like a perfect world, right? Whenever you touch, you cut without char, without smoke, no spark, but coagulating. To understand, I just wanted to show you the company's video. Let's skip through to this side. It works well much more for a surgical world where you just attach this knife, the blade, and keep touching with the precise sect. You can control how much you're touching and then continue on to the sweep. That's more of a continuous application of precise sect. If you have this nice control of the tissue contact, it's beautiful. This is another example. You can see the fat is cut without much smoke and it keeps separating. Whenever you touch, apply the precise sect, it just separates them. There's no bleeding, no much char. That is the precise sect. In the ESD world, that can be a little bit different because we are the one who's controlling how much you cut and this freedom of the contact of tissue is not as much as surgery. This is the actual case. I'm trying to do dissection. This is a semiconductive invasive cancer suspected. I'm just cutting just above the muscle and you can see if you keep touching and apply, not much char and not much smoke. You can see it cuts the semiconductive layer. It cuts the muscle. No separation. It just works well for both types of tissue. One is a really denser but rich in electric-containing fluid. One is the fluid injected in a very sparse connective tissue. When you apply, it just disappears. It almost looks like a cut current. You saw the spark. If there's not much tissue contact, it starts going a little higher voltage and it gives you more sparks. Just separate them. If you apply like traditional technique that you precisely touch and apply this precise sect, it may just give too much of the power. They think it's a distance. It's a resistance and increase the voltage and sparks. If you keep touching and moving, it looks like it's just cutting with a knife. That's the reason why I said yesterday that we're still struggling to find the best application. If you trust too much and just keep cutting with the precise sect, I found myself seeing much more bleeding. Probably the knife is much smaller. If the knife is bigger and probably it creates much more effective coagulation, then it probably is actually better. I want you to see the tissue effect. You saw very nice with the sparks but there's no char at all. You don't have to change the dry cut swift coag. It gives you both of the world. That's kind of a combination. I was told that it works from the power of soft coag all the way to the spray with continuous modulation. If this automatic mode is really suitable for us, we have yet to see. In some cases, it just works beautifully. Amit, do you love the precise sect? Yeah, absolutely. Since I've started using it, this has now become my go-to setting for submucosal dissection. You have to figure out what type of knife you're using, what type of technique you're using. With the precise movement and capturing tissue and you know exactly what you're doing, applying, you can choose dry cut swift coag to your liking. Precise sect may be suitable for you if you're more liberal movement is applied and you want to just keep zapping all the small vessels, not thinking too much about changing modalities. I'm going to skip through. I wanted to mention a little bit about bipolar knife because this is available to us. Initially, it was only available in Japan as a B-knife, but we have the bipolar knife with a blade. The difference is they use a much higher frequency and it creates the similar effect of cut and coagulation. This device doesn't have much of the differentiation of the dry cut or swift coag because it works almost like doing the same thing both ways. It cuts really seamlessly. At the same time, it coagulates and this only one cut applies sort of coagulating cutting. The coagulation is totally different modalities. It's called microwave coagulation. It has a really super microwave. It alternates the positive and negative and it creates electromagnetic radiation. It just increases the temperature slowly. It kind of works from the center of the device to expand slowly outside. It doesn't give you a char, so it has a little longer time to work on it, but it really surely coagulates the vessels. This is the effect of a cut with this new bipolar knife. When you apply it, I have to tell you one thing. The bipolar works from top to bottom, so the electric current is only happening between those probes. It doesn't have to go through the body. Then, if you apply this between tissue, it gives a really consistent effect. You see very few coagulation effects and it just cuts seamlessly. What I found is it's really consistent within the different tissue target. It's the semicolons of fiber. It's really separate as well. It cuts the muscle really cleanly as well. The most surprising thing is the fat-containing tissue. I was cutting without char or too much of the smoke. You see I just made a boo-boo here, but it was just cutting seamlessly on this muscle tissue. This is the effect on the semicolons and muscle layer. This is a microwave coagulation. Again, the same effect comes from top to bottom. This is the area that starts spreading the thermal injury. It seals really nicely. You can see the visible effect of shrinkage and sealing of the vessel. You can see the bubble inside the blood vessel as well. This is a really huge protruding lesion. In the center, there are feeding vessels. The multiple arteries and veins are gathered together. If you apply microwave coagulation, you have to go from the side, exactly the same as Dr. Terunaga explained. You try to compress the vessels and you keep applying for 10 seconds each time. You can see the shrinkage, gradual shrinkage, but to reach the center, it took a long time. Total application was five times of 10 seconds from right to left, left to right, but you don't see the charge. It's just getting really slowly into the center. Once you cut it with the cut current, Oh, I'm coagulating, OK. But now this is a very well-sealed vessel. You can see it's pulsating still. It's a really good sealing effect. And I was able to get rid of this tumor with only microwave coagulation current without any coagulation forceps. So this might be really the major player in the future. I just wanted to introduce the new technology. Thank you very much. Thank you.

Precise Sect

modulated frequency

dissection

smoke-free

char-free