Hybrid technology in flexible endoscopy

1 Kaehler GF, Sold MG, Post S, Fischer K, Enderle MD. Selective Tissue Elevation by Pressure Injection (STEP) Facilitates Endoscopic Mucosal Resection (EMR). Surg Technol Int 2007; 16: 107–12 10 Zhou PH, Schumacher B, Yao LQ, Xu MD, Nordmann T, Cai MY, Charton JP, Vieth M, Neuhaus H. Conventional vs. water-jet-assisted endoscopic submucosal dissection in early gastric cancer: a randomized controlled trial. Endoscopy 2014; 46: 836–842 12 Schumacher B, Charton JP, Nordmann T, Vieth M, Enderle MD, Neuhaus H. Endoscopic submucosal dissection of early gastric neoplasia with a water jet-assisted knife:...

Electrosurgery with water-jet elevation The water-jet provides expanded utility for electrosurgical procedures in flexible endoscopy. The layer-specific elevation creates a fluid cushion in the submucosa of the gastrointestinal tract which protects the adjacent tissue layers e.g. muscularis. Numerous studies document the advantages of the hybrid technique in ESD (endoscopic submucosal dissection), EMR (endoscopic mucosal resection), POEM (peroral endoscopic myotomy) and the ablation of Barrett‘s Esophagus – these application benefits are a direct result of the double function of electrosurgery...

Workstation for hybrid techniques in gastroenterology The gastroenterology workstation offers a broad spectrum of electrosurgical applications in endoscopy. In its full configuration the workstation consists of the electrosurgical unit VIO® 3 , argon plasma coagulation module APC 3 02 and hydrosurgery unit ERBEJET® 2 03 , as well as an endoscopic irrigation pump (EIP 2) 04 . 8 For over 20 years now, we have been using the principle of HF surgery based on automated cut coagulation (endoCUT®) technology in interventional, flexible endoscopy. This has meanwhile become an indispensable part of every...

01 HybridKnife®, T-Type, I-Jet No. 20150-060 02 HybridKnife®, I-Type, I-Jet No. 20150-061 03 HybridKnife®, O-Type, I-Jet No.20150-062 Gastroenterology workstation. with units and modules for electrosurgery, plasma surgery, hydrosurgery and endoscopic irrigation

1 Kaehler GF, Sold MG, Post S, Fischer K, Enderle MD. Selective Tissue Elevation by Pressure Injection (STEP) Facilitates Endoscopic Mucosal Resection (EMR). Surg Technol Int 2007; 16: 107–12 2 Belle S, von Boscamp M, Sold M, Mack S, Pilz L, Ebert M, Kaehler G. Submucosal injection with waterjet improves endoscopic mucosal resection of colorectal adenoma – a randomised controlled clinical trial. Scand J Gastroenterol 2017; VOL. 52, NO. 2, 222–227 2a Belle S, Collet PH, Szyrach M, Ströbel P, Post S, Enderle MD, Kähler G. Selective tissue elevation by pressure for endoscopic mucosal resection of...

Colon adenoma after elevation with water-jet Colon adenoma after resection and elevation with water-jet 8 The ERBEJET®2 allows me to safely apply submucosal injections in mucosal tumors, even with large expansion or a difficult anatomical position. The reliability with which a large fluid cushion can always be created precisely in the submucosa, is impressive. This enables us to “crack” even the toughest cases, so that no adenoma is ever operated on unnecessarily. Prof. Georg Kähler Head of Central Interdisciplinary Endoscopy University Clinic Mannh

10 Zhou PH, Schumacher B, Yao LQ, Xu M-D, Nordmann T, Cai MY, Charton JP, Vieth M, Neuhaus H. Conventional vs. water-jet-assisted endoscopic submucosal dissection in early gastric cancer: a randomized controlled trial. Endoscopy 2014; 46: 836–842 11 R epici A, Hassan C, Pagano N, Rando G, Romeo F, Spaggiari P, Ron-calli M, Ferrara E, Malesci A. High efficacy of endoscopic submucosal dissection for rectal laterally spreading tumors larger than 3 cm. Gastrointest Endosc. 2013 Jan; 77(1): 96–101 12 Schumacher B, Charton JP, Nordmann T, Vieth M, Enderle MD, Neuhaus H. Endoscopic submucosal dissection...

Submucosal dissection after elevation with water-jet Mucosal incision of the tumor (adenoma) with the HybridKnife® I-Type Bleeding can subsequently be coagulated with the HybridKnife® 8 We treat our patients with the HybridKnife® as it provides perfect conditions for fast resection or submucosal endoscopy (e.g. POEM or STER) with a low complication rate. With the water-jet, we create a submucosal fluid cushion which offers protection against perforations as well as compressing the blood vessels and making them highly visible. This reduces bleeding episodes during surgery. However, should bleeding...

Tumor resection with the HybridKnife® HybridKnife® is not just elevating, it also allows me to manage all the other steps of an ESD with the same instrument. In combination with the modes of the VIO® 3 generator, HybridKnife® is my preferred choice for the en-bloc resection of lesions in the GI tract. Prof. Alessandro Repici Clinical Director Endoscopic Diagnostics and Surgery Humanitas Research Hospital, Mil

Tumor in situ prior to elevation Incision of the tumor margin with the HybridKnife® O-Type I started using the HybridKnife® O-Type next to the I-Type in the more difficult to reach areas and learned about the great versatility this knife has to offer. It really makes ESD a single-instrument procedure. It makes a full circumferential incision in a ‘lift-and-cut’ fashion, without having to remove the knife a single time, rather easy. This is true even in retroflex positions. Submucosal dissection of the tumor with the HybridKnife® O-Type ESD with the HybridKnife® creates a resection bed with homogeneous...

Initial clinical finding Mucosa elevation with the HybridKnife® Various endoscopic techniques were developed for mucosa resection. Endoscopic submucosa dissection (ESD) is required for lesions greater than 2 cm due to a high risk of relapse in piece-meal resection. An interesting novel development for performing ESD is given by the HybridKnife® which has become well established over the past 10 years, and which was developed for the en-bloc resection of large dissections. This method is a combination of a water-jet which elevates the mucosa, and a radio-frequency [electrosurgery] technology for...