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ESD with HybridKnife®

  • Early carcinomas
  • Adenomas
  • Other lesions in the gastrointestinal tract
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Operation steps

  • Marking
    Marking

    Before elevation, the lateral safety margin is marked with coagulation points at smallest possible intervals with the lesion demonstrating a peripheral zone of 5-7 mm. The APC non-contact method using the FORCED APC mode is also suitable for this procedure.

  • Elevation
    Elevation

    The HybridKnife is positioned on the mucosa with a slight amount of pressure and an application angle of approx. 20°. With waterjet pressure of approx. 20 bar, the waterjet penetrates the soft mucosa and accumulates in the collagenous fibers of the submucosa, which becomes bloated in a pillow-like fashion.

  • Elevation - continuation
    Elevation - continuation

    The “cushioned” submucosa forms a safety margin to the muscularis, thus minimizing the risk of perforation during initial and circular incision of the lesion when the ESD method is used and when the EMR snare ablation method is employed. The submucosal cushion also provides protection against thermal damage of the muscularis.

  • Incision/Dissection
    Incision/Dissection

    VIO modes ENDO CUT Q and DRY CUT, which are used for initial and circular incision and resection of the lesion, provide optimal cutting features.

  • Coagulation
    Coagulation

    Vessels and blood leakage are coagulated during and after resection with FORCED COAG. Hemostasis is enhanced by the compressive water cushion.