All procedures were performed using a colonoscope (CF-H260; Olympus, Japan) with a transparent cap (D-201-13404; Olympus, Japan) and a gastroscope (GIF-H260J; Olympus, Japan) with a distal attachment (ND-201-11804; Olympus, Japan). A Dual knife (KD-650Q; Olympus, Japan) was used during all ESD procedures. A high-frequency electrosurgical generator (VIO 200S; ERBE, Germany) was set up. An injection needle (NM-200L-0423; Olympus, Japan) was used to lift up the lesion. Hot biopsy forceps (FD-1U-1; Olympus, Japan) or endoscopic metal clips (HX-610-090L; Olympus, Japan) were used to stop bleeding. A mixture of 100 ml of 10% glycerol solution containing 2 ml of methylthioninium chloride and 1 mg of 0.002% epinephrine was used as the injection solution [14 (link)].
Vio 200s
Manufactured by Erbe
Sourced in Germany
The VIO 200S is a high-performance electrosurgical generator designed for use in medical and surgical procedures. It provides a stable and precise output for various electrosurgical applications.
Automatically generated - may contain errors
Lab products found in correlation
Nm 200l 0423, by Olympus (3 mentions)
Hx 610 090l, by Olympus (1 mentions)
D 201 13404, by Olympus (1 mentions)
Gif h260j, by Olympus (1 mentions)
Cf h260, by Olympus (1 mentions)
Kd 650q, by Olympus (1 mentions)
Ec38 i10f, by Pentax (1 mentions)
Itknife2 kd 611 l, by Olympus (1 mentions)
Dualknife kd 650l, by Olympus (1 mentions)
Gif q260j gastroscope, by Olympus (1 mentions)
Gif q260j, by Olympus (1 mentions)
Dualknife, by Olympus (1 mentions)
6 protocols using vio 200s
1
Endoscopic Submucosal Dissection Technique
2
Aerosol Generation During Surgical Procedures
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Five different interventions were evaluated:
Mechanical stress without suction: (double elevator according to Freer, sharp side, model 488,074, KARL STORZ SE & Co. KG, Tuttlingen, Germany).
Mechanical stress with suction: (nasal aspirator according to Ferguson).
Laser treatment: (CO2 laser AcuPulseTM DUO, Lumenis company, Israel). Selected settings: 3.5 W, micromanipulator-guided, continuous power output, spot beam focused on the tissue surface without scanner.
Drilling: (Osseoduo, Bien-Air, Switzerland. milling cutter: 3.5 mm cutting drill, 40,000 rpm).
Electrocoagulation: (VIO®200S, Erbe Elektromedizin GmbH, Germany, 60 W at power level 6, bipolar mode).
3
Endoscopic Submucosal Dissection for Colorectal Tumors
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All ESD were performed by two endoscopists with experience in more than 300 ESD operations. Each patient received standardized bowel preparation prior to endoscopic resection. ESD was performed using a single-channel electronic colonoscope (PENTAX EC38-i10F) after intravenous anesthesia. The procedure included the following steps: argon knife (VIO 200S, ERBE, Germany) was used to mark the tumor 5 mm away from the edge; normal saline mixed adrenaline and methylene blue were injected into the submucosal layer to lift the tumor; the mucosa was incised and the submucosal tissue beneath the tumor was dissected gradually from the muscle layer using a dual knife alone or in combination with a hook knife; electrocoagulation and hemostatic forceps were used when bleeding; the wound was closed with titanium clips (ROCC-D-26-165, Micro-Tech Nanjing, Nanjing, China); the resected tumor were collected for pathological examination.
4
ERCP Guidewire-Assisted Biliary Cannulation
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No medication was used to prevent post-ERCP pancreatitis. All ERCP procedures were performed by an expert endoscopist. For this purpose, the endoscopist used a therapeutic duodenoscope with a triple-lumen sphincterotome and a 0.035” hydrophilic guidewire.
The endoscopist used guidewire-assisted cannulation as a standard method for biliary cannulation. First, the endoscopist positioned the duodenoscope and visualized the papilla. Then, the endoscopist oriented the instrument at 11 o’clock toward the common bile duct. Later, the endoscopist initiated cannulation using the sphincterotome and a 0.035-inch hydrophilic guidewire under fluoroscopic guidance [6 (link)].
The endoscopist used an advanced cannulation technique if entering the bile duct was not possible. In our institution, we performed a precut fistulotomy with a needle knife as an advanced cannulation technique [12 (link)]. The advanced cannulation technique consisted of making an incision near the papillary orifice to create a fistula between the duodenal lumen and the common bile duct lumen [5 (link),13 (link)]. For this purpose, the endoscopist used an ERBE VIO 200S as an electrosurgical unit. Finally, we defined cannulation as successful when fluoroscopy revealed the entry of the hydrophilic guidewire into the main bile duct.
The endoscopist used guidewire-assisted cannulation as a standard method for biliary cannulation. First, the endoscopist positioned the duodenoscope and visualized the papilla. Then, the endoscopist oriented the instrument at 11 o’clock toward the common bile duct. Later, the endoscopist initiated cannulation using the sphincterotome and a 0.035-inch hydrophilic guidewire under fluoroscopic guidance [6 (link)].
The endoscopist used an advanced cannulation technique if entering the bile duct was not possible. In our institution, we performed a precut fistulotomy with a needle knife as an advanced cannulation technique [12 (link)]. The advanced cannulation technique consisted of making an incision near the papillary orifice to create a fistula between the duodenal lumen and the common bile duct lumen [5 (link),13 (link)]. For this purpose, the endoscopist used an ERBE VIO 200S as an electrosurgical unit. Finally, we defined cannulation as successful when fluoroscopy revealed the entry of the hydrophilic guidewire into the main bile duct.
5
Endoscopic Resection Techniques Utilizing Advanced Instruments
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The instruments used in this study included an electronic endoscope (GIF‐Q260J Gastroscope; Olympus Corporation, Tokyo, Japan), ultrasound endoscope (SU‐9000 Circular Scan Ultrasound Endoscope; Hitachi High‐Technologies Corporation, Tokyo, Japan), argon air knife (VIO‐200 S; ERBE Elektromedizin GmbH, Tübingen, Germany), IT‐Knife2 (KD‐611L; Olympus Corporation, Tokyo, Japan), DualKnife (KD‐650L; Olympus Corporation, Tokyo, Japan), disposable multi‐functional knife (Anrui, Zhejiang, China), disposable injection needle (NM‐200L‐0423; Olympus Corporation, Tokyo, Japan), disposable snare (MTNPFS01‐02423180; Nanwei Medical Technology Co., Ltd., Nanjing, China), hot biopsy forceps (HBF‐16/1800; Nanwei Medical Technology Co., Ltd., Nanjing, China), titanium clip (ROCC‐D‐26‐195; Nanwei Medical Technology Co., Ltd., Nanjing, China), transparent peeling cap (Olympus Corporation, Tokyo, Japan), nylon ligation ring (Figure 1 ) (Olympus Corporation, Tokyo, Japan), and transparent ligation cap (Figure 2 ) (Olympus Corporation, Tokyo, Japan). The fluid used for submucosal injection was composed of 250 ml saline, 0.5 mg methylene blue, and 1 mg adrenaline. Intravenous anesthesia was administered with midazolam, meperidine, or propofol.
6
Endoscopic Submucosal Dissection Technique
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ESD was performed through single-channel upper gastrointestinal endoscopy (GIF Q260J; Olympus Corp.) using a high-frequency generator (VIO 200S; ERBE Elektromedizin GmbH). ENDO CUT Q (3 : 2 : 4=effect/cutting duration/cutting interval) was used for both mucosal incision and submucosal dissection. Hemostasis was achieved with FORCED COAG E2, 40 W. Premixed sterilized solution of glycerol (10% glycerol and 5% fructose; Cisen Pharmaceutical, Co., Ltd.) with indigo carmine, and 2 ml of 1:10,000 epinephrine were injected into the submucosa using an injection needle (NM-200L-0423; Olympus Corp.). The DualKnife (KD-650U; Olympus Corp.) was used to mark the lesion margin, followed by an incision and dissection of the lesion. All ESD procedures were completed by the same surgeon with an experience of >100 ESD cases per year, over the preceding 5 years.
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