Now, I'd like to start the EndoGEL ESD hands-on training. I put the EndoGEL plate on the Koken gastroscopy simulator using a docking station. The red circle is the target of today's training. In the EndoGEL ESD hands-on training, we will pass the marking and submucosal injection steps. The first step is the circumferential cutting, and the mucosal pucture will be done at the seven o'clock direction. The cutting is done continuously in the clockwise direction. The second cutting is done from the 5 o'clock to the 12 o'clock in the counter-clockwise direction. Press the M knife slightly and keep going on the mucosa. It's something like a surfing. Control the knob and gently rotate your body to make a counter-clockwise movement. To make a horizontal cutting, lifting the control part is helpful. We call it "boots-up". In this position, you can use right-and-left knob to make a horizontal movement. In order to do the submucosal cutting, exposuring the sumbucosal layer is very important. To do this, we use a traction method using a clip and weight. Now, you can clearly see the exposed submucosal layer. Submucosal cutting is usually from the right to left direction. You should control the catheter carefully to make a best cutting depth. Cut the submucosal layer, fiber by fiber using control-and-cut technique. In the submucosal dissection step, the approach angle is important. The ESD knife should be close to the mucosa. In order to simulate this low approach angle, we are using a few wood blocks like this... Now, the approach angle became lower. The final cutting-line should follow the the mucosal surface to avoid the submucosal tunneling. That's it. The ESD simulation is done. I recommend to do the EndoGEL ESD training 10 times before you try the live pig ESD or a real patient ESD. Thank you very much.
Now, I'd like to start the EndoGEL ESD hands-on training.
I put the EndoGEL plate on the Koken gastroscopy simulator using a docking station.
The red circle is the target of today's training.
In the EndoGEL ESD hands-on training, we will pass the marking and submucosal injection steps.
The first step is the circumferential cutting, and the mucosal pucture will be done at the seven o'clock direction.
The cutting is done continuously in the clockwise direction.
The second cutting is done from the 5 o'clock to the 12 o'clock in the counter-clockwise direction.
Press the M knife slightly and keep going on the mucosa. It's something like a surfing. Control the knob and gently rotate your body to make a counter-clockwise movement.
To make a horizontal cutting, lifting the control part is helpful. We call it "boots-up". In this position, you can use right-and-left knob to make a horizontal movement.
In order to do the submucosal cutting, exposuring the sumbucosal layer is very important. To do this, we use a traction method using a clip and weight.
Now, you can clearly see the exposed submucosal layer.
Submucosal cutting is usually from the right to left direction. You should control the catheter carefully to make a best cutting depth. Cut the submucosal layer, fiber by fiber using control-and-cut technique.
In the submucosal dissection step, the approach angle is important. The ESD knife should be close to the mucosa. In order to simulate this low approach angle, we are using a few wood blocks like this... Now, the approach angle became lower.
The final cutting-line should follow the the mucosal surface to avoid the submucosal tunneling.
That's it. The ESD simulation is done. I recommend to do the EndoGEL ESD training 10 times before you try the live pig ESD or a real patient ESD. Thank you very much.
Nice