The main endoscope used was GIF Q260J (Olympus, Tokyo, Japan); in duodenum bulb, a reverse maneuver is not possible with the GIF-Q260J, so, in all lesions of duodenum bulb, we used GIF-Q260 (Olympus, Tokyo, Japan). When a closed approach was difficult, the endoscope was changed to GIF 2TQ260M (Olympus, Tokyo, Japan). For the injection solution, a mixture of normal saline with 1% indigo carmine dye was used. In the event of poor uptake, an adequate amount of sodium hyaluronate with high viscosity was used. For basic techniques, we performed a precut in the region of the mucosa using a dual knife (KD-650, Olympus, Tokyo, Japan). Then, a mucosal circumferential incision was made using the dual knife or insulation-tipped (IT) knife 2 (KD-611L, Olympus, Tokyo, Japan). Submucosal dissection was performed using the IT knife 2 and/or a dual knife (especially if a dual knife was used for the scar tissue). In the event of active bleeding or if prominent blood vessels were present, hemostasis was ensured using a coagrasper (FD-410LR, Olympus, Tokyo, Japan). A high-frequency surgical unit for cutting and coagulation (Erbotom VIO300D, ERBE, Tubingen, Germany) was employed.
Erbotom vio 300d
Manufactured by Erbe
Sourced in Germany
The Erbotom VIO 300D is a high-performance electrosurgical unit designed for use in medical procedures. It provides precise control over the delivery of electrical current for cutting and coagulation of tissue. The device features advanced technologies to ensure safe and effective operation, but a detailed description of its intended use is not available without the risk of interpretation or extrapolation.
Automatically generated - may contain errors
Lab products found in correlation
Gif q260j, by Olympus (3 mentions)
Kd 650, by Olympus (2 mentions)
Gif q260, by Olympus (2 mentions)
Fd 410lr, by Olympus (2 mentions)
Gif 2tq260m, by Olympus (1 mentions)
Kd 611l, by Olympus (1 mentions)
Kd 612l, by Olympus (1 mentions)
D 201 11804, by Olympus (1 mentions)
Pcf q260ji, by Olympus (1 mentions)
Gif h260, by Olympus (1 mentions)
Hook knife, by Olympus (1 mentions)
5 protocols using erbotom vio 300d
1
Duodenal Lesion Endoscopic Submucosal Dissection
2
Endoscopic Submucosal Dissection Technique
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The endoscopes used were mainly GIF Q260J (Olympus Tokyo, Japan). A mixture of normal saline with 1% indigo carmine dye was used as the injection solution. However, in the event of poor uptake, an adequate amount of sodium hyaluronate with high viscosity was used. For basic ESD, we performed a precut in the region of the mucosa using a dual knife (KD-650, Olympus Tokyo, Japan) before making a mucosal circumference incision using the dual knife or insulation-tipped knife nano (KD-612L, Olympus Tokyo, Japan). ESD was performed using the insulation-tipped knife nano (dry cut, effect 2, and 30 W, or swift coagulation, effect 4, and 30 W), and/or a dual knife (endo cut 1, effect 2, duration 2, and interval 2, or swift coagulation, effect 3, and 45 W). If there was active bleeding or prominent thick blood vessels were encountered intraoperatively, hemostasis was achieved using coagrasper forceps (FD-410LR, Olympus Tokyo, Japan). A high-frequency surgical unit was used for cutting and coagulation (Erbotom VIO300D; ERBE, Tubingen, Germany).
3
Endoscopic Submucosal Dissection for Lesion Removal
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All procedures were performed by experienced endoscopists (who have performed more than 1,000 ESD procedures) at CICAMS with a dual knife (KD-650Q; Olympus Optical, Tokyo, Japan) and a single-channel endoscope (PCF-Q260JI, GIF-Q260J; Olympus) with a transparent hood (D-201-11804; Olympus) attached to its tip. In brief, we marked the normal mucosa that surrounded the lesion at least 5 mm away from the tumor with the dual knife. After the injection of a saline solution with epinephrine (0.025 mg/mL) into the submucosa, an initial cut, also called a precut, was made with a standard needle knife on the oral side of the tumor, and then a circumferential mucosal incision was made around the tumor. All of the anastomotic nails (ANs) needed to be removed by peeling off the tissue surrounding the ANs (see in Figure 1 ). The submucosal injection was repeated during the procedure if necessary, and endoscopic hemostasis was achieved. The tumor was then completely removed by submucosal dissection. After lesion removal, preventive coagulation was performed for all visibly exposed vessels with hot biopsy forceps. Then, endoscopic clips were used for prophylactic closure of defects at the AS. A high-frequency electrosurgical current generator (Erbotom VIO 300D; ERBE, Tübingen, Germany) was used during the marking, mucosal incision, submucosal dissection, and hemostasis.
4
Endoscopic Submucosal Dissection Procedure
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ESD procedures were performed by 2 experienced endoscopists (G. H. Kim, G. A. Song), using a single-channel endoscope (GIF-H260 or GIF-Q260; Olympus Co., Ltd.). Procedures were performed with the patient under conscious sedation with cardiorespiratory monitoring. For sedation, midazolam 5–10 mg and meperidine 25 mg were administered intravenously. Propofol was administered as needed during the procedure. First, dots marking the incision were placed 2 mm beyond the tumor margins with argon plasma coagulation. A saline solution (0.9% saline with a small amount of epinephrine and indigo carmine) was then injected into the SM layer around the lesion, and a circumferential incision was made with a flex knife (Fixed Flexible Snare, Kachu Technology, Seoul, Korea) or insulation-tipped (IT) knife (ESD-Knife, MTW Endoskopie, Wesel, Germany). Then, the normal tissue just beneath the lesion was directly dissected using the flex or IT knife (Figure 2 ). If necessary during the procedure, the saline injection was repeated and endoscopic hemostasis was achieved. A high-frequency electrosurgical current generator (Erbotom VIO 300D; ERBE, Tübingen, Germany) was used during marking, mucosal incision, subtumoral dissection, and hemostasis.
5
Endoscopic Submucosal Dissection of Lesions
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ESD was performed under conscious sedation, with cardio-respiratory monitoring. For sedation, 5 to 10 mg of midazolam and 25 mg of meperidine were administered intravenously; pro-pofol was administered, as needed, during the procedure. First, marking approximately 2 mm outside the borders of the lesion, identified by chromoendoscopy with iodine staining, was made using argon plasma coagulation (APC) (Fig. 1 ). After marking, a saline solution (0.9% saline with a small amount of epinephrine and indigo carmine) was injected submucosally around the lesion to elevate it from the muscular layer. A circumferential mucosal incision was made outside the marking dots by using a hook knife (Olympus, Tokyo, Japan). Next, submucosal dissection was performed, with an insulation-tipped knife (ESD-Knife; MTW Endoskopie, Wesel, Germany), to allow complete removal of the lesion. If necessary during the procedure, the submucosal injection was repeated and endoscopic hemostasis was achieved. A high-frequency electrosurgical current generator (Erbotom VIO 300D; ERBE, Tübingen, Germany) was used during marking, mucosal incision, submucosal dissection, and hemostasis.
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