In the next session, we will have a special technique. Dr. Aikawa, please. Yes, Dr. Fukuda, please, from Jichi Medical University. This is a flush knife, a 2.5mm flush knife. The flush knife is thin, so it is a small caliber that can give suction. This is a ball tip. You can see the ball tip. This ball tip goes through the catheter and is the flush knife. We have finished the region marking with milcozal. In addition, we have also finished the injection of samircosal. Now, Dr. Fukuda will show you how to make the pocket. To make the pocket, I usually use a Samilcosal cap. The Fujifilm SD foot fits easily into the pocket, so I use a Samilcosal cap. The Samilcosal cap is DH28GR with SD foot. The pocket opening is 8mm. In my hospital, we usually use DH33GR. The pocket opening is 7mm. It's a little bit bigger, but it's not a big change. Now, let's start the procedure. Today I will show you how to make a regular pocket. Start by opening the pocket with the oar. Injecting Out The location of the region is on the side of the gas rib, so this is the region. So I take some air, I rotate the scope, and here comes the region. Let me know how big you want your first print to be. It's usually around two or three centimeters, depending on the region. Dr. Fukuda, please tell us how to print conventional pockets. Has there been any change recently? There has been no change in the way pockets are printed, but the opening and closing of the pocket, in the conventional way of printing pockets, opens and closes from the bottom of the ground. In this region, it opens and closes from here to here. The final opening and closing opens and closes to here. Nowadays, the pocket printing method is done in the sewage state, especially for colorectal ESD and diodenal ESD, which does not involve the gravity side. Are all conventional pocket printing done? Sometimes, yes. Or, use the traction method. We use methods like gravity side traction and entry side traction. Gravity side traction and entry side traction? Entry side traction. Regular traction. Here is the printout, Are you training your first move now? Yes, now I am exploring under Mukoza. I want to put it in here, so I press it once and put it in. We're putting it in through the knife now. We're putting it in through the knife capitor. We're putting it in through the knife. Are you putting it in through the knife? We're putting it in through. We're putting it in through the knife capitor. I'm putting it in through the knife, but maybe either works. You need to scrape a little too much. Using the pocket creation method for making a gastric will require frequent sucking. This part is really hard as a normal cap, but STF makes this easy to work with. Now I can get into the shape of the Samucoser. As I get into the space of the Samucoser, the scope is stabilized. When I take my hand off the endoscope, the view of the endoscope doesn't change. The stability of the scope is one of the advantages of pocket creation. I saw Dr. Yamamoto perform ST with two people. Do you usually perform ST with someone holding the knife? Sometimes, yes. For education. Depends on the operator. Tell us why you want to make pockets. Sometimes we go from the outside of the pocket and we check the pocket width and the width. For the pocket width, here is the edge of the pocket. I go from the outside of the pocket here and check. It looks like this. So we're looking at the markings from the edge of the pocket. Right. Okay. Actually, I might be going from the outside of the pocket because this is a small area here. Is it toward the bottom of the markings, toward the left and right side? Or toward the outside of the straight pocket? Is it toward the outside of the pocket toward the back? Yes. Is it toward the outside of the straight pocket? I prefer it toward the outside of the wide pocket, not toward the outside of the straight pocket. In the discussion earlier, one student mentioned the point of widening the pocket. Yes. I think that's an important point. Thank you. It's the pocket. Now that we have created a pocket like this, the next step is to open and close the pocket. Let's look at the gravity side, this is where we'll start opening and closing the pocket. Have you always used the gravity side? Conventional side. Lately I've been using traction and water conditions. Today I'm showing you the conventional pocket creation method. I use the conventional pocket creation method. Do you put in traction before you create the pocket creation method? Usually I do before I create the pocket creation method. If I use the traction method, the fat rail also goes up. If I use the pocket creation method, I can do traction and counter traction. By putting in the blade, the effect is better, but at the same time, water is continuously being pumped into the Luman, so it needs to absorb the water, but it doesn't need to be absorbed. Recently I have been using warm water ESD with gestric ESD. However, most hospitals in Japan do not use ESD for absorption. If you do abdominal drainage, pneumonia will occur. Recently, a nasogastric tube was inserted into the abdomen, but this way the animal cannot inhale water or air. In the United States, I think it is better to use a regular anastiser. Especially for early learners, we judge that perhaps all ESD is necessary. Especially for early learners, we judge that perhaps all ESD is necessary. Fukuda-san is printing the Gravity side, and he is also printing the Enal side. He is also printing the Gravity side. This part is very difficult, but the SD hood can help, it can give you a good view. I think this is the most difficult part of the pocket creation. You have to create this new aspect, the one that depends on this aspect. Yes, sorry. When I was taught about the pocket creation, I always had to create this part myself. Yes, of course. And then I taught it to the pocket creation. Yes, that's the biggest thing. So, nowadays we're using traction. Even in the water. Yes, even in the water. So, it's easier now. There's a little flap here. Great. Are there any cases where you are unable to develop pockets around your stomach or colon? For example, for the abdominal antrum, we use the usual method. How about using an IT knife? In Japan, we don't usually use two devices, When it gets tricky you can of course use two devices. IT knife, Safe knives, etc. Yes, it's a safe knife. Yes, it's a safe knife. In your organization. Yes, thank you. of course. By the way, at GG University, the method for creating pockets is as follows: It was not created, it was predicted. So, we You're learning from experts who are experts. I've finished up to here. Cut off the remaining part. This part, this part, this part. Do you understand that gravity can make a big difference here? This site is not that easy, so it's important to get the dependent site in first. If you do it the other way around, it can be a big problem. OK So that's done. Looks great. If you want to use traction, what kind of traction do you use? Usually, any method is OK, but I usually use a clip'n line. A clip'n line. It's the cheapest. You can use a clip'n line or you can use a clip'n line on the other side. You can use a clip-on line on the opposite side, or you can use a clip-on line on the opposite side. You can also use two clip-on lines. The prices are different in Japan and the US. The cheapest clip-on line in Japan is about $10. But that's okay. In the US, the cheapest clip-on line is about $120. The prices are different. However, the clip-on lines on the market are cheap. There are clip-on lines such as Rubber Band, SureTrack, MicroTec, etc. They are cheap, especially for underwater use. The Clip'n Line Dental Force Technique is described in the text and can also be used in practice. If I have a large bruise, can I use the Pocket Creation Method? The pocket creation method is suitable for larger bruises. For larger bruises, use two pockets. For larger pockets, traction is not as good. Recently I've been using a combination of pocket and traction. For larger bruises, you need traction. There's more traction and the process becomes kamasum. I'm using the pocket creation method, and I'm using a combination of water under and traction. The pocket creation method is using a combination of water under and traction. On this point, I think the combination of combinations is a good idea. I think combination is the most important point. You don't have to be stuck with one thing, and you don't have to be stuck with it. We appreciate you giving us this opportunity to show you and introduce you to the pocket creation technique. Thank you very much.

medical technique

flush knife

pocket creation

gastrointestinal surgery

traction methods

equipment cost