In this video, Dr. Othman (Baylor-St. Luke's Hospital), demonstrates grasping and retraction of tissue using DiLumen C2's Ig Grasper during an Endoscopic Submucosal Dissection (ESD).
Inadequate tissue retraction and control are significant challenges of performing ESD. DiLumen C2 may improve visualization and dissection speed during such complicated procedures via its novel end-effectors. The effectors give advanced endoscopists and colorectal surgeons more interoperative control by grasping and retracting tissue. Simultaneously, the double-balloon platform maintains a stable position within the anatomy, and relative to the tissue target while dissection is carried out.
double balloon and a liminal intervention platform. Most flexible Gaspar expedites chronic and this cop pics of mucosal dissection chronic Is these challenging for several reasons. One of them is the thing Colin Wall. On the result of that, there is a limited expand ability of the Kalanick sub mucosal space. So unlike that Sophocles and the stomach that when we inject, we get this very nice, uh, sub mucosal left that allow us to dissect easily, you may not get this expansion in the colon. Also, the Kalanick muscular is appropriate. It can easily be disrupted with any wrong movement with the knife, or simply by applying an extra pressure by the tip of the endoscope or by the cap. In some patients clinic, looping is a problem because it add to the instability of the position off the scope and make the ASD harder. And also, some legions are located behind folds or around corner, which can complicate the dissection process. Because of the difficulties during clinic is thes traction devices were invented to expedite the procedures by exposing the sub mucosal space and providing a clear playing for dissection. How can we create that traction in the past people use clip with the line. People used external grasping forceps or snare alongside the scope, and also they use of double channel in the scope and using this accessory channel for adding a snare or forceps or rat tooth toe. Grasp this issue and allowed traction, although all the above examples we mentioned are doing significant attractions. But they're not providing what you are calling dynamic traction. What we mean by dynamic traction. Dynamic traction allows the ability to manipulate the leisure in multiple directions. For example, you know, move it to the right to the left a little bit. This way or that way. It also provide adequate and variable Tish attention for dissection. Sometimes you want the tension to be higher or lower. It also allowed the re grasping of the lesion from another edge to change the direction off the tension. In this video, we describe double balloon and criminal intervention platform with a flexible grasp ER, which allows the stabilization of the colon, creating a therapeutic known for the performance off E. S. D. And provides dynamic traction with the use of flexible grasp er alongside the endoscope. Our patient described in this case was 72 years old, who was referred for endoscopic sub mucosal, a section off six centimeter tubular adenomas Palop in the sigmoid colon. And given the size of the region, the possibility of early adenocarcinoma we have elected to do E. S. D in this video demonstrates the usefulness of this novel technique and the removal of six centimeter polyp in the signal colon. After advancing the kaleidoscope along the device to the side of the Legion, the four Pallone of the device was advanced to the aural side of the legion to create the therapeutic zone. The palate was then examined carefully and it showed tubular pattern was mild irregularities but no sign of deep invasion, such as lots of vascular tea or distorted pattern. After careful examination of the Legion, the region's margin were marked using dual knife J with soft calculation. Current affect 5 51. The Legion margin were then left it using a sub mucosal injection Asian off a compound solution composed off 500 cc. If his span Once you see open different and three cc off methylene blue, it's important to ensure that all the margins of the legion are raised uniformly to avoid forming valleys in between the inject eights who prefer the technique off injecting all the region margins at once to expedite the circumferential incision. After that, we utilize dual knife to perform the circumferential incision around the region. We're using Indo cut queue mode and ensuring careful separation off the legions margin from the surrounding mucosa by repeated dissection of the sub mucosal plane was swift calculation mode and we use effect 3 35 What after adequate separation of the anal side of the Legion from the surrounding mucosa, The flexible Grasp ER was introduced under direct visualization and maneuver to create attraction separating the lesion from the underlying muscle layer. As you can see here, the flexible grasp er allowed us to utilize the dual knife far away from the legion, which can increase the knife maneuverability and also allowed us to utilize the traction off the flexible grasp er effectively. In occasions when the Indust was preferred to have a closer look at the subject was a plane. The device allows the scope to advance under the grasp er, to provide closer look with micro movement, particularly to dissect fiber closer to the edge of the legion. Repeated sub because an injection is now performed toe, allow easier sub mucosal dissection under traction. As you can see here, the flexible Grasp ER was constantly maneuvered to provide the adequate tension needed to maintain the traction. Repeated sub because of dissection, is now performed carefully and slowly tow. Avoid any deep injury to the muscle layer under the legion. After dissecting the majority of the legion, the four Pallone is now retracted toe Allow sub because the injection off the other side off the lesion. After that, the flexible grasp er was reoriented to grasp the edge of the lesion toe. Allow the final dissection. As we can see here, we have a very limited sub Nichols the space, but we still are able to provide adequate attention to maintain the traction needed to perform the final cut off the region. Post McKusick homicide was carefully inspected and showed no perforation. The site off the dissection was closed completely using endoscopic searching device. The procedure was performed in 70 minutes. Pathology showed well differentiated adenocarcinoma was depth of invasion into superficial, said Nikos, Off 198 micro millimeter peripheral and deep margin, or clear Noel Info, vascular or paranoia? Invasion was seen. So this was a curative resection. I would like also to highlight here the depths off sub mucosal which was dissected in this case, was 1100 or four micro millimeters. So in conclusion, double balloon into interventional platform was flexible. Grasp er provided a reliable, dynamic traction which significantly expedited cla Nikias D in this case.