colonic FTRD®

colonic FTRD® for full-thickness resection in colon and rectum To colonic FTRD®
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Description

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  • Description
  • Technical data
  • Application
  • Media

Use of the colonic FTRD®

Instrument for flexible endoscopy, for full-thickness resection and diagnostic tissue acquisition through removal of suitable lesions in the colorectum.

The colonic FTRD®

The colonic FTRD® consists of an applicator cap with a ready-to-use mounted FTRD® clip, integrated HF snare and thread. Included are the thread retriever for easy retrieval of the release thread, the endoscope sleeve with fixation tapes and FTRD® hand wheel.

For application, the applicator cap is mounted on the endoscope with the snare running on the outside of the scope and the sleeve preventing entrapment of any tissue between scope and snare. By turning the hand wheel, the thread is tensioned and the clip released. Using the integrated snare, the target tissue is cut above the clip.

The size of the colonic FTRD® is suitable for endoscopes with a diameter of 11.5 – 13.2 mm and a working channel diameter of at least 3.2 mm.

The colonic FTRD® Set

The colonic FTRD® is delivered as one procedure set and consists of the following products:

  • colonic FTRD®
    – elongated OTSC® System cap (size 14) with preloaded clip and thread
    – FTRD® snare integrated into cap’s distal end
    – FTRD® hand wheel
    – thread retriever
    – endoscope sleeve with fixation tapes
  • FTRD® Marking Probe
  • FTRD® Grasper

Before purchasing and using the FTRD®, participation in a training course is mandatory.

Dimensions and specifications

FTRD technical data
Cap diameter (outside)21 mm
Cap depth23 mm
Appropriate endoscopesEndoscope diameter: 11.5 – 13.2 mm
Working channel diameter: min. 3.2 mm
Packaging unit1 piece included in colonic FTRD® Set
Reference number of the colonic FTRD® Set (incl. FTRD® Marking Probe und FTRD® Grasper)200.70

Important notes

The colonic FTRD® is compatible with all commercially available colonoscopes. All FTRD® products are disposable and designed for single patient use.

Application of the colonic FTRD®

Full-thickness resection

Marking of the lesion with
the FTRD® Marking Probe

Insert the endoscope to the resection site and adjust lesion

Grasping and mobilizing
the lesion with
the FTRD® Grasper (1)

Grasping and mobilizing
the lesion with
the FTRD® Grasper (2)

Ensure lesion is completely in the cap
Fix FTRD® Grasper
Apply clip

Resect tissue and retrieve specimen

Example 1*:

Procedural sequence EFTR of a recurrent sessile adenoma (non-lifting sign) in the descending colon

Markierung der Läsion (mit FTRD® Marking Probe) bevor das FTRD® montiert wird

Marking of the lesion (with FTRD® Marking Probe) before mounting the FTRD®

Greifen der Läsion mit dem FTRD® Grasper

Grasping of the target tissue with the FTRD® Grasper

Sicherstellen, dass sich das Zielgewebe vollständig in der FTRD® Kappe befindet und Clipapplikation durch Drehen des Handrads.

Retrieval of target tissue into cap and fixation

Gewebe in die Kappe hineinziehen und fixieren

Confirm that target tissue is completely within the FTRD® cap and release clip by turning the hand wheel

Schließen der Schlinge und HF-Resektion des Zielgewebes; Bergen des Resektats und Überprüfen der Resektionsstelle

Closure of snare and electrical cut of tissue; retrieval of resected sample and check of resection site

*Source: Prof. K. Caca and Dr. A. Schmidt, Klinikum Ludwigsburg, Dept. of Internal Medicine, Gastroenterology, Hemato-Onkology, Diabetes and Infektious Diseases, Germany

Example 2*:

De novo resection after incomplete polypectomy in the descending colon (early carcinoma)

Zustand nach inkompletter Polypektomie im Colon descendens (Frühkarzinom

Status after incomplete polypectomy in the descending colon (early carcinoma)

Mit Koagulationspunkten markierte Läsion

Tissue marked with FTRD® Marking Probe

Resektionsstelle nach FTRD®-Einsatz (Gewebe zuvor mit Tusche markiert)

Resection site after FTRD® procedure (tissue previously marked with Indian ink)

*Source: Prof. K. Caca and Dr. A. Schmidt, Klinikum Ludwigsburg, Dept. of Internal Medicine, Gastroenterology, Hemato-Onkology, Diabetes and Infektious Diseases, Germany

Example 3*:

Resection of a relapsed adenoma (HGIEN) in the descending colon (non-lifting sign)

Adenomrezidiv im Colon descendens, Non-lifting sign

Relapsed adenoma in the descending colon, non-lifting sign

Zustand nach Vollwandresektion mit FTRD®, alle Darmwandschichten sind im Querschnitt zu sehen

FTRD® resection site: all layers of the bowel wall to be identified in cross section

Vollwandresektat, ca. 2,5 cm

Full-thickness sample, approx. 2.5 cm

Histologie zeigt komplett entferntes Adenomrezidiv, HGIEN

Histology: completely resected recurrent adenoma, HGIEN

*Source: Prof. K. Caca and Dr. A. Schmidt, Klinikum Ludwigsburg, Dept. of Internal Medicine, Gastroenterology, Hemato-Onkology, Diabetes and Infektious Diseases, Germany

Hybrid-FTRD® – Combination of EMR and FTRD®

Lesion with positive lateral lifting sign and central non-lifting part

Injection of solution into submucosal layer in area with positive lateral lifting sign

Resection of lateral parts with snare in piece-meal technique

Switch to FTRD® and grasp remaining non-lifting central part of lesion with FTRD® Grasper

Application of FTRD® Clip and resection of tissue with integrated snare

Animation of the Hybrid-FTRD® procedure

Example 1*:

Resection of a large cecal adenoma with the Hybrid-FTRD® technique – (Click here to see the corresponding clinical video)

OVE_Hybrid-FTRD_Caca_Cecal_adenoma_2
OVE_Hybrid-FTRD_Caca_Cecal_adenoma_4
OVE_Hybrid-FTRD_Caca_Cecal_adenoma_6
OVE_Hybrid-FTRD_Caca_Cecal_adenoma_7
OVE_Hybrid-FTRD_Caca_Cecal_adenoma_8

*Source: Prof. K. Caca and Dr. B. Meier, Hospital Ludwigsburg, Germany

Example 2*:

Resection of a recurrent sigmoidal adenoma with the Hybrid-FTRD® technique – (Click here to see the corresponding clinical video)

OVE_Hybrid-FTRD_Schmidt_Recurrent_sigmoida_adenoma_1
OVE_Hybrid-FTRD_Schmidt_Recurrent_sigmoida_adenoma_3
OVE_Hybrid-FTRD_Schmidt_Recurrent_sigmoida_adenoma_4
OVE_Hybrid-FTRD_Schmidt_Recurrent_sigmoida_adenoma_5

*Source: Prof. A. Schmidt, University Medical Center Freiburg, Germany

Example 3*:

Resection of an approx. 35 mm large non-lifting adenoma (LST granular type) in the sigmoid colon; Follow-up after 3 months without recurrence

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Follow-up after 3 months without recurrence after resection with Hybrid FTRD

*Source: Dr. M. Bauermeister, Sana Klinikum Lichtenberg Berlin, Germany

Example 4*:

Resection of an approx. 25 mm large non-lifting recurrent adenoma (LST granular type) in the upper rectum

25 mm large non-lifting recurrent adenoma in the upper rectum
hybrid FTRD in the upper rectum
mobilisation of non-lifting recurrent adenoma with FTRD System
FTRD clip placed in the upper rectum

*Source: Dr. M. Bauermeister, Sana Klinikum Lichtenberg Berlin, Germany

FTRD® at the appendix

Schematic illustration oft he EFTR procedure of a polyp involving the appendiceal orifice.

*Source: Rogier Trompert Medical Art, www.medical-art.nl

Here an animation of the procedure is shown.

Clinical Example*:

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appendix clinical picture
appendix clinical picture

*Source: Bronzwaer M, Bastiaansen B, Koens L et al. Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a prospective observational case study. Endosc Int Open 2018; 06: E1112–E1119

Clinical Video Example:

Prof. K. Shishin MD, Moscow Clinical Research Center, Russia
Click here to see the clinical video

Dr. B. Bastiaansen, UMC Amsterdam, Netherlands
Click here to see the clinical video

Media

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