Monopolar HF instrument for endoscopic submucosal dissection (ESD) with flushing and reinjection capability.

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Use of the AqaNife®

Instrument for flexible endoscopy for dissection of tissue e.g. in endoscopic submucosal dissection (ESD) and for haemostasis during this prodecure.

The AqaNife®

The AqaNife® is a monopolar electrosurgical instrument for dissection using flexible endoscopes with a working channel diameter of minimum 2.8 mm. It is a fixed dissection knife and provides the following advantages:

  • Precise marking of tissue
  • Defined fixed position of the needle, no back pushing by tissue contact
  • Straight needle (1,5 mm and 2,5 mm) for flexibility of dissection angle
  • Ceramic cap as a stopper and a protector
  • Reinjection without instrument change, flushing function

Dimensions and specifications

Slider (A) for feeding forward (1) and retracting (2) the dissection electrode
HF connector (3 mm) (B)
Flexible shaft with irrigation channel (C) Shaft length: 220 cm
Straight HF knife (needle-shaped electrode) for dissection and coagulation of tissue (D) Needle lengths: 1.5 mm | 2.5 mm
Irrigation connection (E)
Appropriate working channel diameter From 2.8 mm
Packaging unit 1 piece
Article number 200.53.01 ; 200.53.03

Application of the AqaNife

Marking
Injection of LiftUp®
Incision of 4⁄5 of the total circumference
Endoscopic submucosa dissection with AqaNife® and additional grasper through the AWC®

Example *:

* Source Prof. Dr. A. Meining, University Hospital Ulm, Germany [ex-vivo model]

Marking
Injection with LiftUp®
Circumferential incision (with AqaNife® or snare tip)
Endoscopic submucosal dissection with AqaNife®
Resection in EMR+ technique (snare, grasper and AWC®)

Endoscopic Submucosal Dissection consists of several steps. The first step is usually the placement of coagulation marks around the lesion with a safety margin. This facilitates identification of the resection margin during the procedure. The AqaNife® can be used for this step.

The next step is submucosal liquid injection to lift the mucosa from the muscular layer. Then follows the incision of the mucosa and the subsequent RF-dissection of the submucosal space with the tip of the AqaNife®.

Lost fluid, occurring during dissection over time, can be replaced without instrument change by gently inserting the tip of the AqaNife® into the submucosa and fluid injection.

Besides the AqaNife® also the Coag Dissector can be used for tissue dissection. As in surgical dissection, the specially shaped jaws of the instrument can be applied to gently spread the tissue and bluntly dissect the submucosal space. Also bleeding can be stopped, applying the Coag Dissector as a coagulation grasper.

Mucosal incision (circular; not too deep, because of perforation risk) around the fistula opening with the AqaNife® (Ø ~15 mm)
Positioning of the clip in the incision line
Clip application and closure of the fistula

Example *:

* Source: Meining A. et al. (2015) Erfolgreicher Verschluss einer großen ösophago-bronchialen Fistel durch mukosale Inzision vor OTSC-Clip-Platzierung. Endoskopie heute. Doi: 10.1055/s-0035-1545049.

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