Waterjet submucosal dissection of porcine esophagus with the HybridKnife and ERBEJET 2 system: a pilot study

Abstract

Background and study aims Esophageal endoscopic submucosal dissection (ESD) is technically difficult because of narrow working spaces and ease of perforation due to the lack of serosa. HybridKnife is a recently developed ESD device that is combined with the high pressure waterjet ERBEJET 2 system to lift mucosa. We hypothesized that this waterjet could make submucosal dissection safer and studied this in porcine esophagus. Materials and methods Water pressures of 30 – 70 bar were tested to determine the appropriate pressure for waterjet ESD with HybridKnife (WJ-ESD) in one pig. WJ-ESD safety and completion were compared with those of conventional ESD using DualKnife (C-ESD) as a reference. Each of three virtual esophageal lesions in two pigs were resected alternatively using both methods from the lower to upper esophagus. For WJ-ESD, the submucosa, apart from hard fibrous tissues, was dissected using water pressure alone. Results Using 50 bar of water pressure resulted in the best balance between proper dissection and view-disturbing water backflow. The dissection speeds for the lower, middle, and upper esophagus were 0.2, 0.9, and 0.2 cm2/min in 50 bar WJ-ESD and 1.1, 0.5, and 1.0 cm2/min in C-ESD, respectively. Minor bleeding was frequent in WJ-ESD, but was easily stopped by electrocoagulation with the same needle. No perforation was observed in either procedure. Thermal damage to dissected tissues appeared mild, and the extent of muscle injury was lower for WJ-ESD (4, 6, and 8 %) compared with C-ESD (14, 16, and 7 %). Conclusions WJ-ESD could be completed safely for porcine esophagus with less damage to the muscle layer compared with C-ESD.

The waterjet necrosectomy device for endoscopic management of pancreatic necrosis: design, development, and preclinical testing (with videos)

“…The WAND is designed to deliver a flow rate up to 0.5 L/minute at a maximum surface pressure of 1.3 bar-well below a tissue safety threshold of 3 bar [5][6][7]. Both the flow rate and force generated by the WAND are higher than irrigation volumes and pressures generated by commercially laparoscopic irrigation systems used during laparoscopic surgery in the peritoneal and retroperitoneal cavities, yet lower than high pressure water jets used for surgical hydrodissection.…”

Robotic waterjet wound debridement – Workflow adaption for clinical application and systematic evaluation of a novel technology

“…pressure range with a 120-μm jet nozzle is 1–80 bar (100–8,000 kPa) with a volume flow of 1–55 ml/min as a laminar liquid jet. The ERBEJET 2 provides a versatile waterjet surgery platform for various applications in open as well as in endoscopic surgery [ 15 , 16 ].Water pressure was set to 50 bar. Suction for all trials was performed with a separate, hand-guided suction device.…”

Dynamic and static sealing performance of elastic check valve spool

“…Due to the material performance and cost advantages [1], the use of elastic non‐metallic material as the control valve spool in water medium has the advantages of simple, safety, and stability [2], and has potential for application in the medical and food industry [3]. For example, a check valve with a pressure of 10 MPa and a flow rate of <0.2 L/min is an indispensable component in the development of medical water jet equipment [4, 5]. The elastic material in the check valve replaces the valve spool, seal, and spring in the original metal valve as the new valve spool, and the study of its dynamic and static sealing performance is extremely important for the flow control system [6].…”