clinical bulletin otsc proctology - Ovesco Endoscopy AG

the OTSC ® Proctologymodes of applicationOTSC ® clip application is an established procedure for treating fistulas and anastomoticleaks in the digestive tract 1–6) . Now OTSC ® is also available for proctology 7) .Clinical application4 Two resorbable U-shaped suturesof a minimal length of 90 centimetersare placed through the sphincter mus-4• Rapid, minimally invasive, surgical procedure• Easy transanal clip application by ergonomic one-hand operated instrument• Closure of anastomotic leaks• No relaxation or rupture of suturescle centering the internal opening ofthe fistula in a cross-like fashion.5 The sutures are knotted at theirdistal end to allow them to be pulledthrough the working channel of theclip applicator using the Thread Retriever(included in OTSC ® ProctologyThese features and therapeutic functions of the system are The use of the OTSC ® Proctology system is based on a specialbased on material selection and design: the superelastic handheld applicator device for transanal use. In addition, forNitinol ® is biocompatible and, if needed, even suited and support of the application two accessories are available: theapproved to be applied as a long-term implant. The dynamic OTSC ® Fistula Brush for debridement of the fistula tract andtissue compression enabled by the superelastic material adapts the OTSC ® Proctology Anchor for alignment of the internalto thickness and texture of the tissue grasped and readjusts fistula opening with the applicator cap.depending on the actual requirements of the situation/tissue.This avoids overcompression and at the same time ensuresconstant pressure delivery to the tissue which makes it alsomost suitable for the treatment of anorectal fistulas andanastomotic leakages.OTSC ® Proctology with clip and applicator and accessories1 Before application of the OTSC ®Proctology it must be guaranteed thatno abscess of major infection has developedin the course of the fistula.This can be achieved with the placementof a seton drainage at least threemonths before clip application.The technique of clip application dependson the application site withinthe anorectum: unlike the anal canal,the rectum is not supplied with somatosensorynerves and therefore notsubject to pain.2 To avoid that the clip will be appliedon the very sensitive anodermrather than on the stable sphinctermuscle, a circular area of anodermabout two centimeters in diameteraround the internal opening of thefistula is excised. In the rectum, thispreparation is not required.3 For fistula preparation the specialbrush can be used to remove all ofthe granulation tissue lining the fistulatract. Therefore the seton for drainage123ca. 2 cmdelivery).6/7 By holding the sutures underslight tension, the preloaded clip applicatoris advanced towards the internalopening of the fistula. The applicatorhas to be parallelly aligned to theaxis of the anal canal to achieve ananatomical orientation of the bent clipwithin the anorectum. The applicatorcap is then brought in stable contactwith the exposed sphincter musclearound the opening of the fistula.After deactivation of the safety-lock,the clip is released.8 If performed correctly, the appliedclip closes the internal openingof the fistula by digging its teeth intothe sphincter muscle and compressesthe proximal fistula tract. If the sutureshave guided the clip applicator appropriately,the sutures must be seen inthe center of the captured tissue withinthe clip after removal of the applicator.They can either be knotted for additionalclosure of the fistula or cut off.8567is attached to the lug of the brush forsimplified insertion of the brush. Afterdebridement of the fistula tract byalternating movements of the brush,the tract is rinsed with saline. Theshaft of the brush can be left in placeto indicate the internal opening of thefistula.