ESD Brochure (PDF 881.5 KB) - ERBE Elektromedizin GmbH

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APPLICATION In the following we wish to take a closer look at some special aspects concerning elevation and dissection of the mucosa and demonstrate some further advantages of the ESD method using the HybridKnife. Diagnosis/localization Reduction of bleeding During elevation of the mucosa, initial diagnostic prognoses in terms of tumor infiltration can be made because tumor-infiltrated lesions which occur in the colon in particular cannot be elevated. Should no elevation be detected during waterjet activation, despite having set the effect correctly, this is indicative of a tumor which has infiltrated deeper tissue layers. In this case, the indication for curative ESD is no longer given. Through the water pressure, small capillary blood vessels within the submucosa cushion are compressed. The result: bleeding is reduced and the view of the target area remains unimpaired. Unlike needle injection, use of the waterjet practically rules out risk of injury to blood vessels. This aspect ensures additional reduction of possible bleeding. An additional diagnostic tool which facilitates the detection and visual identification of tumor boundaries is a contrast medium which can be added to the separation medium. The altered tissue of the lesion already becomes visible through elevation alone. However, the contrast medium makes the difference between healthy and pathological tissue even more distinct. Should any bleeding nevertheless occur, it can be rinsed using the waterjet and coagulated afterwards electrosurgically. Figure 1: The tumor is visualized using contrast medium Figure 2: Reduction of bleeding, thus good view of the operating field 08 HybridKnife
Protection against perforation R0 resection of relatively large lesions In the case of needle injection, the separation medium is injected underneath the mucosa. Here the risk of injuring blood vessels arises. When performing the needle-injection procedure, a change of instrument is required if fluid is added in the course of the intervention, and thus the tendency is to perform resection using a less pronounced submucosal cushion. This in turn increases the risk of thermal and mechanical perforation of the muscularis. Using the ESD method, large-surface tissue lesions can also be resected en bloc. The resection bed has a smooth resection surface which heals homogenously and with practically no scarring approximately 4 weeks post-operatively. Since waterjet elevation can be performed at any time, it is possible to keep the cushion volume constant during and after dissection and resection. Thus the safety margin to the muscularis is preserved. Figure 1: Waterjet elevation is possible at all times Figure 2: Homogenous resection bed free of bleeding after ESD with HybridKnife Aspects of cost The separation medium used for ERBEJET 2, a common physiological saline solution, is much more cost-economic than the solution enriched with additives which is used for needle injection. Administering needle injections requires force, in particular when fluids with a high degree of viscosity are involved. And a further aspect of cost-efficiency is that when using the waterjet method, no additional personnel is required for assisting in the elevation process. As a multi-function probe, the HybridKnife performs all four working steps: marking, elevation, incision/dissection and coagulation. No additional two-channel endoscope is needed for performing ESD with the HybridKnife; a singlechannel endoscope fulfills all the requirements. HybridKnife 09
Page 1 and 2: E L E C T R O S U R G E R G Y / W A
Page 3 and 4: ERBE VIO electrosurgical unit ENDO
Page 5 and 6: HybridKnife The flexible, multi-fun
Page 7: The working steps Figure 1: Marking
Page 11 and 12: advise on use BIBLIOGRAPHY On the b

ESD Brochure (PDF 881.5 KB) - ERBE Elektromedizin GmbH

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