Waterjet-assisted TEM-ESD with ERBEJET® 2

Indications

  • Adenomas, rectal, broad-based, non-muscle invasive
  • T1 low risk carcinomas

Advantages of ERBE equipment

  • High-pressure waterjet for mucosal elevation
  • Layer-specific procedure
  • Elevation requires no injection
  • No risk of injury to vessels
  • Waterjet pressure can be adjusted depending on lesion, tissue layer and area of application.
  • En-bloc resection

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Pump (single-use)

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Operation steps
Waterjet elevation with ERBEJET® 2

Waterjet elevation with ERBEJET® 2

The waterjet technique creates a submucosal edema which permits the surgeon to dissect precisely between the submucosal and muscular layers. Blood vessels which run through the elevated layer are easily distinguished for coagulation and dissection with the high frequency needle knife.

Incision and circular opening of the mucosa with HF current

Incision and circular opening of the mucosa with HF current

The cushioned submucosa creates a safety margin to the muscularis, minimizing the risk of perforation - both when incising and cutting circularly around the lesion in ESD procedures.

Dissection

Dissection

Dissection starts at the distal end of the lesion by cutting sequentially through the mucosal and submucosal layer reaching finally the muscular layer. Optimal resection properties and a high degree of safety during resection is provided by use of the ERBE VIO Modes such as ENDO CUT Q, DRY CUT or SWIFT COAG.

Re-elevation

Re-elevation

The cushion remains in place during resection. If necessary the fluid cushion can be re-elevated by further ERBEJET activations to ensure that its protective function will remain in place for the duration of the resection.

Checking the completeness of the resection

Checking the completeness of the resection

Finally the completeness of the resection is controlled. The resected specimen is pinned on a cork plate, measured and sent to the pathology department for examination of the margins and definitive histology.