ENDO CUT® I Papillotomy procedures with ENDO CUT® I

INTRODUCTION03 TECHNOLOGY04 ENDO CUT I Cutting cycle Coagulation cycle Equipment User interface Expert mode Activation and activation signals General information General parameter settings Operative techniques Recommended Settings RECOMMENDED SETTINGS AVOIDING COMPLICATIONS Important information While Erbe Elektromedizin GmbH has taken the greatest possible care in preparing this brochure and compiling the recommended settings, we cannot completely rule out errors. The information and data contained in the recommended settings cannot be used to justify any claims against Erbe Elektromedizin GmbH....

Over the past few years ENDO CUT has established itself as an accepted electrosurgical modality in endoscopic papillotomy procedures (EPT*). ENDO CUT I of the Erbe VIO System is a further development of the ENDO CUT offered by the “Erbotom ICC” series which was successfully used for more than 10 years. This brochure is intended to help users understand ENDO CUT I and to use it correctly in their clinical practice and provides information both for endoscopists and for the entire endoscopy team. This brochure was created in close cooperation with experienced endoscopists working in different medical...

Coagulation cycle Cutting cycle Coagulation cycle Cutting cycle Cutting stage Initial incision stage Cutting interval 01 Intermittent cutting mode ENDO CUT I: cutting cycle (yellow), coagulation cycle (blue). 02 Cutting cycle with ENDO CUT I: initial incision stage (yellow/blue), cutting stage (yellow) and coagulation cycle (blue). ENDO CUT I The fractionated cutting mode ENDO CUT I is characterized by alternating cutting and coagulation cycles (Fig. 1). This makes it possible to carry out controlled cutting with sufficient hemostasis during the entire cutting process, which supports the work...

03 When cutting with a papillotome, small arcs (yellow) are created between the cutting wire of the papillotome and the tissue. 04 Coagulation during cutting. A coagulated area (gray/white) is created in the vicinity of the cutting wire. CUTTING CYCLE COAGULATION CYCLE a) Initial incision stage A cutting cycle always begins with a short initial incision stage of varying duration (Fig. 2). It serves to heat the tissue in the immediate vicinity of the cutting wire endogenously to 100° C (212º F) within a few tenths of a second, leading to a tiny initial coagulation (hemostasis) of the tissue just...

ENDO CUT I in the Expert mode Equipment ENDO CUT I is a consequential further development of ENDO CUT, a wellknown feature of the ICC units. The Endo Cut IQ mode, an optional upgrade, is available for the electrosurgical VIO units, some of which can be retroactively equipped with the mode. A complete system for endoscopic procedures could consist of the following (Fig. 5): User interface of the VIO system VIO electrosurgical unit VIO electrosurgical unit Argon Plasma unit APC 2 and Endoscopy irrigation pump EIP 2 Integrated on the VIO cart. USER INTERFACE ENDO CUT I is a cutting mode. This means...

08 Anatomical view during a biliary papillotomy procedure: sphincter of Oddi (blue), sphincter muscle of the choledochal duct (gray), gastroduodenal artery and branching blood vessels (orange/red). ENDO CUT I with Effect setting 1: cutting current (yellow) without coagulation. 09 Direction of the incision in a biliary papillotomy procedure. General information General parameter settings Papillotomy procedures are performed to open up the bile duct or the pancreatic duct. Depending on the indication, this means that the sphincterof the papilla and the choledochal duct must be either partially...

12 Cutting duration and extent of incision: left side = Setting 1, limited length of cut; right side = Setting 4, greater length of cut. Cutting cycle Cutting duration setting 1 Cutting cycle Cutting intervall setting 1 ENDO CUT I with a very short cutting duration: Setting 1. ENDO CUT I with a cutting interval set to Setting 1: the c oagulation cycle (blue) with the shortest possible cutting interval. Cutting cycle Cutting duration setting 4 Cutting cycle Cutting intervall setting 10 ENDO CUT I with the longest cutting duration: Setting 4. ENDO CUT I with a cutting interval set to Setting 10:...

17 Introduction of the papillotome and direction of the cut in biliary papillotomy procedures. The markings at the distal tip of the papillotome indicate how deeply the papillotome is inserted. The arrows show the direction of the incision carried out to open up the papilla. To find the bile duct, the opening of the papilla must be examined carefully to discover where bile is secreted. In cases where access is more difficult, the papillotome is placed at the opening of the papilla and the choledochal duct is identified after injection with contrast medium. Alternatively, papillotomes with guide...

Operative techniques 19 Direction of the incision in papillotomy procedures. The large black arrows indicate the direction of the incision when opening the papilla. The small arrows marked with an ‘l’ show the direction of the current flow during cutting. a) Activation time The yellow pedal of the foot switch is used to activate the cutting function of ENDO CUT I. The foot switch must remain pressed down continuously until the papilla has been sufficiently incised and opened. The goal with every incision made using electrosurgical current is to create a controlled, smooth cut with as much coagulation...

Needle-knife papillotomy. a) The needle-knife is placed on the papilla and a slight pressure is exerted. b) The papilla is gradually opened, layer by layer, along the dotted line using PreCut. Different types of papillotomes: a) with a guide tip; b) without a guide tip; c) precut papillotome; d) flat needle papillotome; e) round needle papillotome. PRECUT PROCEDURE SPECIAL FEATURES OF PAPILLOTOMES If selective cannulation of the bile or pancreatic is unsuccessful, it will sometimes be necessary to open the roof of the papilla in order to better identify the duct openings. This is also referred...