ESD with HybridKnife
Endoscopic Submucosal Dissection - fast, safe and easy with the HybridKnife
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With the HybridKnife, ERBE has taken the ESD resection technique a critical step forward. All working steps of ESD can be performed without changing instruments. The HybridKnife combines the functions of electrosurgery with those of waterjet surgery in one instrument. |
Indications
- Early carcinomas
- Adenomas
- Other lesions in the gastrointestinal tract
Advantages of ERBE equipment
- No change of instrument necessary, thus shorter operating times
- eparation medium can be replenished quickly at any time
- Mechanical and thermal protective function of water cushion is preserved throughout the entire process of resection
- Good view of the operating site: risk of bleeding is minimized (blood vessels are compressed by the water cushion)
- Waterjet pressure can be adjusted depending on lesion, tissue layer and area of application.
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Operation steps
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Step 1: Marking
Before elevation, the lateral safety margin is marked with coagulation points at smallest possible intervals with the lesion demonstrating a peripheral zone of 5-7 mm. The APC non-contact method using the FORCED APC mode is also suitable for this procedure.
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Step 2: Elevation
The HybridKnife is positioned on the mucosa with a slight amount of pressure and an application angle of approx. 20°. With waterjet pressure of approx. 20 bar, the waterjet penetrates the soft mucosa and accumulates in the collagenous fibers of the submucosa, which becomes bloated in a pillow-like fashion.
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Step 2: Elevation - continuation
The “cushioned” submucosa forms a safety margin to the muscularis, thus minimizing the risk of perforation during initial and circular incision of the lesion when the ESD method is used and when the EMR snare ablation method is employed. The submucosal cushion also provides protection against thermal damage of the muscularis.
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Step 3: Incision/Dissection
VIO modes ENDO CUT Q and DRY CUT, which are used for initial and circular incision and resection of the lesion, provide optimal cutting features.
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Step 4: Coagulation
Vessels and blood leakage are coagulated during and after resection with FORCED COAG. Hemostasis is enhanced by the compressive water cushion.
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