Traction‐assisted colorectal endoscopic submucosal dissection using the Mucosectom2 device
Traction‐assisted colorectal endoscopic submucosal dissection using the Mucosectom2 device
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DOI：
10.1111/den.12919
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发表时间：
2017-11
影响因子：
5.3
通讯作者：
Y. Yamasaki;K. Harada;H. Okada
中科院分区：
文献类型：
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作者：
Y. Yamasaki;K. Harada;H. Okada
我们开发了Mucosectom 2，一种用于粘膜下剥离的特殊器械（HOYA Pentax，Tokyo，Japan）（图1A），并报告了其有效性。Mucosectom 2与其他刀具相比有两个优点。首先，它保护肌肉层免受热损伤，因为尖端覆盖有绝缘轴。第二，它切割细小的血管而不会导致出血，因为它的刀片和血管的接触面积比其他刀大。因此，Mucosectom 2基本上是安全的，即使不能清楚地看到粘膜下层，也可以将其切开。然而，事实上，我们在一些结直肠内镜粘膜下剥离术（C-ESD）病例中遇到了术中出血和困难的情况。我们判断，如果采用良好的牵引方法，使用Mucosectom 2的C-ESD的安全性可以进一步提高。我们已经开发了牵引辅助的带线夹的C-ESD（TAC-ESD）（图1B），以保持粘膜下层的良好可视化，但该技术已被描述为使用尖端型刀。从理论上讲，使用Mucosectom 2的TAC-ESD似乎是最好的组合。因此，我们在知情同意后将该技术作为试验应用。在插入结肠镜之前准备好线夹，并像往常一样进行粘膜下注射和粘膜切开。然后将夹和线应用于样本的肛门侧。轻轻拉动缝线可获得良好的粘膜下层可见性。然后可以使用Mucosectom 2（快速凝固模式，effect 2 40 W，VIO 300 D;埃尔贝，T€ubingen，德国）轻松进行粘膜下剥离。线夹在剥离区域产生足够的张力，Mucosectom 2在其上滑动，保护肌肉层，从而实现有效的剥离。此外，术中出血的风险被认为极低，因为切开血管的可见性良好（图2A-E;视频S1）。
We developed the Mucosectom2, a special instrument for submucosal dissection (HOYA Pentax, Tokyo, Japan) (Fig. 1A), and reported its effectiveness. TheMucosectom2 has two benefits compared to other knives. First, it protects the muscle layer from thermal injury because the tip is covered with an insulated shaft. Second, it cuts fine vessels without causing bleeding because the contact area of its blade and vessel is larger than that of other knives. Thus, basically, the Mucosectom2 is safe and allows the submucosal layer to be dissected even if it cannot be visualized clearly. Nonetheless, in fact, we have encountered intraoperative bleeding and difficult situations in some colorectal endoscopic submucosal dissection (C-ESD) cases. We judge that the safety of C-ESD with the Mucosectom2 can be further improved if a good traction method is applied. Traction-assisted C-ESD with clip-and-thread (TAC-ESD) (Fig. 1B) has been developed by us to maintain good visualization of the submucosa, but the technique has been described with a tip-type knife. Theoretically, TAC-ESD using theMucosectom2 seems to be the best combination.We therefore applied this technique as a trial after informed consent. A clip-and-thread is prepared before insertion of the colonoscope, and submucosal injection and mucosal incision are carried out as usual. The clip-and-thread is then applied to the anal side of the specimen. Good visibility of the submucosal layer can be obtained by pulling the thread gently. Submucosal dissection can then be easily carried out using the Mucosectom2 (swift coagulation mode, effect2 40 W, VIO300D; ERBE, T€ubingen, Germany). The clip-and-thread creates sufficient tension in the dissection area, and the Mucosectom2 slides over it, protecting the muscle layer so that efficient dissection can be achieved. Furthermore, the risk of intraoperative bleeding is considered to be extremely low, as there is good visibility of the incised vessels (Fig. 2A–E; Video S1).