POEM was performed for achalasia types I to III, unresolved esophagogastric junction outflow obstruction, and/or spastic oesophageal disorders. A high-definition gastroscope (GIF 290, Olympus, Tokyo, Japan), fitted with a transparent cap (Olympus, Tokyo, Japan), was used. Insufflating carbon dioxide was used throughout the procedure. Submucosal tunnelling was established from 10 to 15 cm above to 2 cm below the esophagogastric junction using an ERBE Endocut Q 3:1:1 current with either a triangle-tip knife (Olympus Tokyo, Japan) or Hybridknife (ERBE, Germany). Selective myotomy was performed according to manometric findings and achalasia subclass. A Coagrasper (FD410-R, Olympus, Tokyo, Japan) was used for pre-emptive coagulation of large vessels or haemostasis when needed. After completion of myotomy, the mucosal incision was closed using through-the-scope clips.
Hybridknife
Manufactured by Erbe
Sourced in Germany, Japan
The HybridKnife is a versatile laboratory equipment designed for precise cutting and dissection tasks. It combines both mechanical and thermal cutting capabilities, allowing users to seamlessly transition between different cutting methods as required by their specific application.
Automatically generated - may contain errors
Lab products found in correlation
Triangle tip knife, by Olympus (2 mentions)
Vio300d, by Erbe (2 mentions)
Transparent cap, by Olympus (1 mentions)
Gif 290, by Olympus (1 mentions)
Vio 3, by Erbe (1 mentions)
Flush knife, by Fujifilm (1 mentions)
Mh 588, by Olympus (1 mentions)
Gif h190, by Olympus (1 mentions)
Cf fh260azi, by Olympus (1 mentions)
Cf hq290i, by Olympus (1 mentions)
Cf h260ai, by Olympus (1 mentions)
Pcf q260al, by Olympus (1 mentions)
Gif h260, by Olympus (1 mentions)
Gif q260j, by Olympus (1 mentions)
Dualknife, by Olympus (1 mentions)
Kd 640l, by Olympus (1 mentions)
7 protocols using hybridknife
1
Peroral Endoscopic Myotomy for Esophageal Disorders
2
Endoscopic Submucosal Dissection Techniques
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Endoscopic submucosal dissections were performed by using Fujifilm colonoscopes 9 (Fujifilm, Tokyo, Japan) (EC-760R-VL/EC-760ZP-VL). CO2 gas was used in all cases. Two types of electrosurgical generators (VIO 300D or VIO 3, ERBE, Tübingen, Germany) were used. The knives were Flush-knife (Fujifilm, Tokyo, Japan) or HybridKnife (Erbe Elektromedizin, Tübingen, Germany). The technique adopted for the ESD (Figure 4 ) was chosen according to operator preference and included either the “conventional” [21 (link)], pocket [22 (link)], or tunnel technique [23 (link)]. Various traction methods to better expose the submucosal layer were applied [24 (link)]. Local injection was performed with either saline or glyceol with indigo carmine.
3
Peroral Endoscopic Myotomy Procedure
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All the procedures were performed by QC and assisted by an advanced endoscopic fellow. All procedures were performed under anesthesia and CO2 insufflation. A gastroscope (GIF-H190; Olympus, Tokyo, Japan) with a transparent distal cap attachment (MH-588; Olympus, Japan) was used at our endoscopy suite for the procedure. Procedure methods and evaluation were described in our previous study [13 (link)]. All the patients were placed on a clear liquid diet for 72 h before the procedure and kept NPO the night before planned POEM. First, a routine upper endoscopy was performed. For each POEM, a mucosal bleb was created in the posterior esophageal wall 10–15 cm above the gastroesophageal junction (GEJ), and a 2-cm longitudinal mucosal incision was made to reveal submucosal layer. Mucosotomy was performed by a Hybrid knife (ERBE, Germany) or a triangle tip knife (Olympus, Japan), extending a submucosal tunnel to approximately 2 cm into the gastric cardia. Once the cardia was reached, a circular myotomy was performed in a retrograde fashion starting in cardia extending proximally into the middle esophagus. The mucosotomy was then closed by placement of endoclips (Micro-Tech, Nanjing, China).
4
Endoscopic Submucosal Dissection Technique
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A high-definition endoscope (GIF-H260, GIF-Q260J, CFH260AI, CF-HQ290I, or PCF-Q260AL; Olympus Co., Tokyo, Japan) or a high-definition, magnifying colonoscope (CFFH260AZI; Olympus Co.) was used for the procedures performed in Korea. An electrosurgical unit (VIO300D; ERBE, Tubingen, Germany) was used during the procedure. The main device for mucosal incision and submucosal dissection consisted of a fixed flexible snare knife (Kachu Technology Co., Seoul, Korea), a dual knife (Olympus Co.), or a hybrid knife (ERBE, Tubingen, Germany). Sodium hyaluronate solution with a small amount of indigo carmine was used for the submucosal injection in all ESD procedures [5 (link)]. After careful inspection of the lesion, a submucosal cushion was created by injecting the solutions into the submucosal layer and the submucosal dissection was followed by a mucosal incision around the lesion. The details of the ESD technique have been previously described (Fig. 1 ) [5 (link),15 (link)].
5
Endoscopic Submucosal Dissection Technique
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All ESDs were performed by a single endoscopist (A.K.), an interventional endoscopist specializing in ESDs. ESD involved marking of the lesion, circumferential mucosal incision and submucosal dissection with simultaneous hemostasis. After circumferential marking of the lesion, a saline solution containing epinephrine (0.01 mg/ml) and indigo carmine was injected into the submucosal layer underneath the lesion to elevate the lesion from the muscular layer. A circumferential incision was made in the mucosa using a HybridKnife® (ERBE Elektromedizin GmbH, Tuebingen, Germany) and the submucosal layer was dissected until the lesion was completely resected. All specimens were reviewed by an expert gastrointestinal pathologist and classified according to the Vienna classification of gastrointestinal neoplasia.25 (link)
6
Peroral Endoscopic Myotomy for Achalasia
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POEM procedures were performed as previously described by Inoue et al. using high-definition gastroscopes fitted with transparent caps under general anesthesia and insufflation using carbon dioxide 16 (link). Either a triangular tip knife (KD 640 L, Olympus, Japan) or HybridKnife (ERBE, Tubingen, Germany) was used. In brief, after a submucosal bleb was created, a longitudinal mucosal incision was made and the endoscope then entered the submucosal space. The submucosal fibers were dissected and a submucosal tunnel was extended 2 cm – 3 cm into the proximal stomach (Fig. 2 ). Subsequently, either selective myotomy of the inner circular muscle bundles or full-thickness myotomy was performed (Fig. 3 ). The length of myotomy was determined based on the findings at high-resolution esophageal manometry and/or the proximal level of visible spastic contractions observed endoscopically. Mucosal entry was closed using endoscopic clips (Video 1 ).
7
Hybrid-knife for Bladder Elevation
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The Hybrid-knife (ERBE, Germany) was a multifunctional probe combining water-jet and electrosurgical technology. The water jet was applied through a stainless steel tube incorporating a microcapillary lumen with a diameter of 120 μm, which was connected with a generator, and can rapidly elevate the bladder mucosa and submucosa by the fluid cushion. During the operation, the Hybrid-knife was fixed into the sheath of a 24 F WOLF cystoscope, which allowed the flexible movement to adjust the distance to tissue.
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