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TriangleTipKnife

Model KD-640L

Dr. Haruhiro Inoue / Dr. Hitomi Minami /
Dr. Yoshitaka Sato

Showa University Northern Yokohama Hospital

Interview With The Expert

What are the advantages of TriangleTipKnife?
First, it does not need any kind of axis alignment. It can hook effectively in any direction.

Also, by discharging spray coagulation, the submucosal layer will be dissected without any contact of the knife.

Are there any weak points of TriangleTipKnife?
When there is serious fibrosis in submucosal dissection,

it is better to use a hook because it has a thinner distal end than TriangleTipKnife.

Under what conditions do you use other devices as well?
If the dissected part of the mucosa starts dangling when you are about to resect,

it’s easier to complete the procedure using ITknife.

Applicability of TriangleTipKnife

Difficulty per region

◯ : Easy.  No mark: Ordinary.  △ : Difficult. : Very difficult.

Cardiac region  △  
 Fornix    
 Lesser curvature of upper body    
 Greater curvature of upper body  △  
 Anterior wall of upper body    
 Posterior wall of upper body  △  
 Lesser curvature of middle body    
Greater curvature of middle body    
 Anterior wall of middle body    
 Posterior wall of middle body  △  
 Lesser curvature of lower body    
 Greater curvature of lower body    
 Anterior wall of lower body    
 Posterior wall of lower body  △  
 Lesser curvature of anterior wall  ◯  
 Greater curvature of antrum  ◯  
 Anterior wall of antrum  ◯  
 Posterior wall of antrum  ◯  
 Pyloric ring    

Note for beginners: The most difficult regions are the upper part and posterior wall side of the stomach.

Sedation
Intravenous anaesthesia Premedication General anaesthesia Monitoring
Opistan (pethidine hydrochloride)*
35 mg + Horizon (diazepam)*
10 mg + Dormicum (midazolam)*
Appropriately
Buscopan,
(scopolamine butylbromide)*
1 ampule
Perform the procedures in the operating room under general anaesthesia when it is expected to take more than two hours. SpO2, ECG and blood pressure are monitored in all cases.

 

Electrosurgical unit VIO-300D
(Erbe)
ESG-100
(Olympus Medical Systems)
Marking
Device Caution Setting
TriangleTip
Knife
Retract the knife and gently contact it to the mucosa and briefly supply current. SprayCoag
60W Effect1
ForcedCoag1
20W
Local injection
  Epinephrine Indigo carmine  
Glyceol
(concentrated
glycerin fructose)*
Used
1 ampule
per 200 ml
Used
(appropriate
amount)
Advantage: Low price
Disadvantage: Short lifting time
Sodium
hyaluronate
Not used Used Advantage: Long lifting time
Disadvantage: High price
Use saline in circumferential incision. For submucosal dissection, use hyaluronic acid to reserve the view with sufficient bulging, and perform dissection with the knife tip.
Circumferential incision
Device Caution Setting
TriangleTip
Knife
For precutting, gently apply the triangular tip to the mucosa and briefly supply current in the EndoCut or PulseCut mode. Once the muscularis mucosae have been cut and the submucosal layer is exposed, advance the mucosal incision along the depth. For circumferential incision, hook the tip while applying tension to the mucosa using an attachment and supply current for further incision.
For the tip to hook properly, be sure to supply sufficient tension.
●EndoCutQ
Effect 2
Cut duration1
Cut interval6
●DryCut 50W
Effect3
PulseCut
slow 20W
Submucosal dissection
Device Caution Setting
TriangleTip
Knife
Slide the endoscope into the submucosal layer using the attachment to apply tension. Then supply current while directly confirming the target. Avoid hooking the muscle layer during output. Use sodium hyaluronate for local injection. SprayCoag
60W Effect1
ForcedCoag2
60W
Haemostasis
Device Caution Setting
TriangleTip
Knife
For spurting type of bleeding, contact the knife tip to the bleeding point for coagulation. Also effective to do haemostasis by contacting the retracted knife tip to the bleeding point. SprayCoag
60W Effect 1
ForcedCoag2
60W
Coagrasper If haemostasis using the tip of TriangleTipKnife is difficult, use Coagrasper to grasp the bleeding point and supply current for 2 or 3 seconds in the SoftCoag mode. It is important to confirm the bleeding point to grasp it accurately. SoftCoag
80W Effect5
SoftCoag 80W
Preventive haemostasis
Device Caution Setting
TriangleTip
Knife
Coagulate the visible vessels in advance. Small vessels can be cauterised by performing coagulation with the tip of TriangleTipKnife. For large vessels, use Coagrasper to grasp and cauterise in SoftCoag mode. SprayCoag
60W Effect1
ForcedCoag2
60W
Coagrasper SoftCoag
80W Effect5
SoftCoag 80W
Perforation measure
Method Timing
A small perforation with a size of pinhole is to be obstructed with a clip for conservative treatment. The basic is to obstruct the hole with a clip immediately after perforation.
If clipping is difficult, it is sometimes recommended to incise or dissect a little further and retry clipping.

* May not be available in your area.

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