ESD with HybridKnife®

Indications

  • Early carcinomas
  • Adenomas
  • Other lesions in the gastrointestinal tract

Advantages of ERBE equipment

  • High-pressure waterjet and electrosurgery in a single instrument
  • No change of instrument
  • Shorter operation times
  • Water cushion for mechanical and thermal protection
  • Minimized risk of bleeding (blood vessels compressed by water cushion)
  • En-bloc resection and R0 resection possible

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Operation steps
Marking

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.

Elevation

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.

Elevation - continuation

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.

Incision/Dissection

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.

Coagulation

Coagulation

Vessels and blood leakage are coagulated during and after resection with FORCED COAG. Hemostasis is enhanced by the compressive water cushion.