POEM using HybridKnife®
- Esophageal motility disorders
The mucosa is lifted above the initial esophageal stenosis at the 2 o’clock position3 (alternative: 5 o’clock). As a result of the high-pressurewaterjet elevation, layer-specific accumulation of the separation medium occurs beneath the mucosa, creating a submucosal cushion.
Incision / Dissection
Using the electrosurgical function of the HybridKnife, the mucosa is opened to a length of approximately 2 cm(3) at around 5 cm above the stenosis.
While alternating between the waterjet and the electrosurgical function of the HybridKnife, a submucosal tunnel is created. Thanks to the high-pressure waterjet, a protective layer is established to the mucosa which protects it from mechanical and thermal damage. The tunnel is prepared to approximately 2 cm below the gastroesophageal junction.
Using the HybridKnife, a myotomy is then performed of the sphincter, beginning at around 3 cm below the location of the incision up to approximately 2 cm beneath the gastroesophageal junction. Possible bleeding can be immediately coagulated using the HybridKnife. Following the myotomy, the cut is covered using the intact mucosa and the incision location closed using clips.