Reasonable Application of ESU

Reasonable Application of ESU

Medical high-frequency electric knives have been widely used in both open surgery and endoscopic surgery. Both types of electric knives have their own characteristics, and different electric knives are used to achieve surgical results for different lesions:

Benefits of using medical high-frequency electric knives under endoscopy:

Through the endoscope interface, the use of high-frequency electric knife under endoscope has obvious advantages, which can reduce a lot of unnecessary pain. Besides less trauma, it can also speed up the operation process, reduce the labor intensity of medical staff, reduce or avoid surgical bleeding, and alleviate the pain of patients. High frequency electric knife is also relatively effective in removing lesions and can achieve the goal of curative treatment.

Through several specific cases, one can intuitively understand how to choose specific instruments

(1) Cervical polyps: It is generally suitable to use a high-frequency electric knife. The snare should be inserted under the endoscope, and the cross-sectional area of the electric knife should be close to the polyp side rather than close to the intestinal wall. For long pedicle polyps, the snare should be inserted at least 3mm away from the intestinal wall.

The selection of the position of the trap is crucial. When the trap is not properly positioned for electrocautery, do not tighten it. If tightened too tightly, it can cause premature mechanical cutting and lead to bleeding. It is also important to control the head of the mirror to keep the trapped polyp in view

(2) Non cervical polyps: Some polyps with a diameter less than 0.5cm can be removed using thermal biopsy forceps or directly sprayed with argon gas. Grasp the polyp with a hot biopsy forceps, then cut off the polyp, or use an argon knife to spray argon gas until the polyp turns a burnt yellow color.

The use of a snare is appropriate for the removal of pedunculated polyps with a diameter of 0.5-1.0cm.

For pedunculated polyps with a diameter greater than 2.5cm, the method of using a snare to remove them in blocks and in stages should be adopted, generally divided into 3-6 times, with continuous block removal. Block cutting involves placing one side of the snare wire at the junction of the polyp and the normal mucosa, and the other side resting on the high part of the polyp. Tighten most of the area surrounding the head of the polyp, apply electrocoagulation current, and cut it off

The specific type of electric knife to be used in clinical practice should be based on the specific situation, and high-frequency electric knives should be reasonably used in endoscopic surgery.