| [ Summary ] |
The development of endoscopic submucosal dissection (ESD) has made possible en-bloc resection of lesions regardless of size or shape. However, ESD is associated with a high level of technical difficulty and a high incidence of complications. In order to perform ESD more easily, safely, and efficiently, we invented water jet short needle knives (FlushKnife™). We have developed the FlushKnife along with Fujinon corporation. It has a tip portion. The “VIO 300D” (ERBE) was used as an electro surgical generator. A 4 mm attachment was put on the endoscope tip in order to conduct treatment as follows ; We performed mucosal incision of the entire circumference, using the 1.5 or 2 mm tip in the Endo-cut I mode. Then, the submucosal layer was dissected using a 1.5 or 1 mm tip in the forced coagulation 40 W mode. A Hook knife was also used in situations where muscle layers were located in front of the target tissue. Shortening of the projecting part of the needle knife tip enabled performance of easy, safe mucosal incision, as well as submucosal dissection. Emitting a jet of water from the tip of a sheath provides lavage of the viewing field, identification of the bleeding points and ability to perform submucosal local injections without replacement of devices, which led to very efficient treatment. The FlushKnife can be considered to be one of the most useful operative instruments for colorectal ESD treatment. |