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Prior to elevation, the tumor is marked around in a circle with coagulation points, which also represent the later line of resection. The lateral safety margin to the border of the tumor is about 5–7 mm. Using the waterjet function, the tumor is elevated by injecting within the marked points. The separation medium accumulates in the submucosa and forms a safety margin to the muscularis. This reduces the risk of perforation during the following resection.

The tumor is resected after cutting around it at the raised resection level. The modes DRY CUT® or ENDO CUT® Q provide a high-quality cut with optimal hemostasis. Repeating the elevation provides a good presentation of the cut level (beneath the tumor) and contributes towards achieving the desired R0 resection. Vessels or seeping bleeding occurring during or after the resection can be coagulated with FORCED COAG®.

ESD with HybridKnife – a technique is making its mark The waterjet function for elevation of the lesion-bearing mucosa in endoscopy THE ADVANTAGES OF ESD IN THE GASTROINTESTINAL TRACT (GIT) The endoscopic submucosal dissection (ESD) is an internationally established technique for the treatment of early carcinomas in the gastrointestinal tract. ESD with HybridKnife is simple and safe, with a steep learning curve. The four work steps, marking, elevation, incision/dissection and coagulation, can be performed without an instrument change. In this way, non-muscle-invasive tumors and early carcinomas...

Can the application advantages found in the GIT be transferred to urology? After marking using the electrosurgery function and after elevation, the tumor can be resected and hemorrhages can be coagulated Past experience with resection of tumors of the bladder using HybridKnife suggest this. Because, like the walls of the organs of the gastrointestinal tract, esophagus, stomach and intestine, the layers of the bladder have a similar structure: mucosa, submucosa and muscularis. The principle of elevation is the same, as also are the further individual steps of en bloc resection of a bladder carcinoma...

TUR-B snare resection putting the standard to the test The method of choice until now: TUR-B with snare. Using the monopolar or bipolar technique. METHOD-DEPENDENT RISK OF RECURRENCE The conventional transurethral snare resection has up until now been the method of choice for minimally invasive removal and pathological diagnosis of bladder tumors. However, tumors with a diameter greater than 7 mm cannot be resected en bloc. The tumor must be fractionated, which contradicts current oncological recommendations. By cutting up the tumor, it is possible for tumor cells to be released, which can lead...

En bloc resection of tumors of the bladder using HybridKnife En bloc resection of bladder tumors. All individual steps are performed with HybridKnife and without changing instruments. A NEW, PROMISING ALTERNATIVE? The bladder tumor can be resected in one piece using the electrosurgery function of the HybridKnife instrument. By elevating the mucosa, the resection level is raised and the risk of perforation of the muscularis is reduced. The en bloc technique permits a more accurate pathological evaluation after the resection. Complete removal of the tumor can be verified on the basis of a contiguous...

The HybridKnife models We recommend these probe types for use in the bladder: I-Type: Versatile in use, high degree of freedom T-Type: The model with the best properties for preparing and working under tension, very good coagulation properties Setting recommendations Marking FORCED COAG, effect 2, 50 watts Elevation Effect 20–30 Incision/Dissection DRY CUT®, effect 3-5, 70 watts ENDO CUT® Q, effect 2, cutting duration 4, cutting interval 4 Coagulation FORCED COAG, effect 2, 50 watts HybridKnife T-type ø 2.3 mm; length 1.9 m No. 20150-060 HybridKnife I-type ø 2.3 mm; length 1.9 m No. 20150-

The Urology Workstation Resection of tumors of the bladder using HybridKnife. And further applications in the urology tract. Based on the electrosurgery module VIO® 300 D with the additional modules Waterjet Surgery and Argon Plasma Coagulation, the VIO Urology Workstation is virtually an all-round specialist in the OR. You will find further applications in urology on our web site: erbe-med.com Urology Workstation VIO® 300 D (Electrosurgery) APC® 2 (Argon Plasma Coagulation) ERBEJET® 2 (Waterjet Surgery) ESM 2 (Aspiration System) Bipolar Resection Adapte

References * Repici A. et al, High efficacy of endoscopic submucosal dissection for rectal laterally spreading tumors larger than 3 cm, Gastrointest Endosc 2013; 77: 96-101. Schumacher B. et al, Endoscopic submucosal dissection of early gastric neoplasia with a water-jet assisted Hybrid-Knife: A Western single centers’s experience, Gastrointest Endosc 2012, 75:1166-74. Schumacher B. et al, Water-jet assisted endoscopic submucosal dissection (ESDH) in comparison to conventional ESD technique for treatment of early gastric cancer, Gastrointest Endosc 2012, DDW abstract accepted. Neuhaus H. et al,...