Chapters Transcript Video Lecture: Are We Now Ready to Take the "3rd Space" Training-Wheels Off and Revisit Traditional NOTES in the “2nd Space"? Pinghong Zhou, MD, PhD, gives a presentation on his recent work/endoscopy technique, and also revisits the traditional NOTES procedure. Let's let's go with our prerecorded lecture now from Professor job. The title is are we now ready to take the third space training wheels off and revisit traditional notes In the 2nd space. All right, here we go. Good afternoon ladies and gentlemen, it's my great honor to join these years. Long Island Alive and that's covered. I'm paying your zoo from Shanghai tongji Hospital for the university today. I would like to introduce our recent work on the thunder endoscopic technique on the first signatory section. And the notes are we now ready to attack the third space training worse off. And I revisited traditional notes in the second space mm as a window compared to the microscopy and does copy flexible and dot copy can really have a first easy access and the second it is a real or less invasive. The procedure is simple and it is safe. It has a big advantage. We can use a flexible endoscope to read too. And those copy and the reverse or to the second endoscopic procedures compared to surgery. Endoscopic resection of the flexible endoscopy. It has an equally infective at a minimum investing. It has no scar on the skin. The trauma is simple and the patient's recovery is very quick actually. It has a low complication rat and the high quality of life after the industrial resection in this section. I would like to introduce first four seconds resection. Best notes. And the second seven because you generate technique Urz. And the last is a news with the panel. This is a mucosa tumor in the catholic body on the screening we found this is leading and the city scanning us shoot relation was in an extra lumina cruise. Can we remove such relations on the endoscope? So we performed for significant resection. Nothing means Katia mucosa, sub mucosal edema, Sanders, rosa. And the Putin scope into the had been nominal cavity. After waiting the economic capital of the relations was removed. I think this is a real notes. After that. We'll use several cliffs within the loop. So switching Want after the four sickness resection for a sickness resection and searching technique is from our point of view. Now it is a foundation for the notes. There's another interesting kiss on the clothes cop we found as happened because tumor located at his orifice of appendix. So us should the lesion was comes from the muscle area. So when the 1st 2nd is respecting, we cut that Clearly of the 2nd along the orifice With the 89th and Hook Knife. After that we put the scope into the abdominal cavity and dissected the appendix from the essentially um during a dissection we found that here is an active in leading point from the appendix. A tree. Was it cocoa grasp such bleeding's was stopped successfully. So after that with bisected appendix with the item knife. So after four signatory section. This is the one in the second and this is a resected specimen. So I think this is a Pantech Tommy with the first significant resection on the telescope. How to close that effect. I want out of forensic mystery section. The traditional technique I think is a clip. So this is my first case. I was the first significant resection In 2000 in 2006 August. So some this is something because of humor in located in the founders. After four significant section we can find the want is the founders. And with the section the greater momentum comes into the lumen of the stomach with several clips. Such defect was successively closed with clips from the Olympus. So we're first obviously our work in the search colonoscopy in 2000 and 11 search girl endoscopy Jonah. So here we can find it. That's a customer with the first significant section. The correlations was success fully bisected and this is a want and this is a great momentum from the ones we can see this is a liver and it's a tight group. Earlier we used several clips to close that not the fact. So as we know traditional instruments for surgery. The want is a clip here. I want to introduce our please in the work perform finished in our center the patient warm it fresh blood. So during the during the industrial examination we found huge suffering because humor and the kid of the tumor we can hear is the bleeding point. So with this technique the correlations was successively dissected. So and this is a want How to close this one. I think we use that several clips from the Boston. Scientific took clothes from the you stop to the programmer in s failures here after after claudia with several clips, the whole Want was successfully closed. Sometimes we find it is very difficult for some from crisis 2nd Mucosa. So this is a want opening of the tender in the failures after the bomb procedure. So just because the patient Has a long history of the Dysplasia, about 30 years. During the procedure we found there are severe for brushes in the opening of the tender so the clip cannot successively clues. Yeah. Opening of the tender. So we're used we're used okay, nice To make two horse along to opening. So then we put the two arms of the slip into the into the smokers. Along they along that thunder along that opening. I was a tender. So after that. So now we can fix that. Took the arms of the clip into. Into the who horse and he's asked. And this difficult difficult opening can be successful. Player louis. And we name this technique as answered the future with the Metallica cliffs for bigger preparations are bigger ones in china. Well, now always used a string searcher technique with clips and and look in the past years, we always used double china's go. And recently we changed to the normal scope with one working channel two clues the herd effect. So with several clips to fix the envelope in the edge of the world. We then can use the hook. Two clues. Such the clothes and the look so is that they want can be successfully closed. This is a whole procedure of the nw So during the selection procedure sometimes we can find the pair the tears of the sleep far off into the lumen would decide over the outside of the limit. So during the location of the envelope we always use the foreign border. Foresee. Oh could just keep the chaos strike. I only want they were close to work close to like it the envelope so that our clips Can stand on the one. So with the experience of the forest sickness reception we then decided to perform some news procedures. So from the our experience the first signatory section makes the notes. Now survive for your bladder stone. I think the standard procedures is L. C. That cross copy consists tech to me. So with experience I was first in this resection with your side we can now use the and those cops as a microscope to perform the and those copycat currencies technomic easy. So no we can first we'll make a access in the engine. They ain't putting a score. I would decide I was the stomach. Now that scott comes into the a phenomenal capital. So with SD technique we inject we use the hybrid knife a type first injected selling into the into the path of the cord blood. Then with this technique. Now her plan is a horrible as can be expected to the horribly and actually angle so with the caveat prosper the artery can be calculated. And and this is that why are attacked so well with location or the envelope to the oil that the core blood can be accepted from the core blood pet. And then we use is a sneer, remove focus is a cord blood from the economic committee towards the stomach and remove and remove it from the patient's mouse. This is a whole procedures. I was a and those go back closest agreement. So in this afternoon I will have live the moon from shanghai to Long Island to Perform one case of endorsed court closest technomic in our and those center. Not in the operating room without any help of the look Roscoe. So this short video shoot the procedures of that easy. So when you first injected sailing into the paraphernalia of the cord blood. Yeah remote. Holy her core blood from the occasion. Smiles early on the endoscope. And this this is a procedure of the fire touch and this and the loop. So now we use this near to remove the blood from the patient's mouth. You know. Well we finished. Yeah. So it has it cases and those got this technology for this gold plated that we can find the bladder was full of the Stores there about 240 stores within the globally. I have friends. So yeah there are two access for you and those coptic on September one is trans rectal access. So the trans actor access. The advantages the access that is straight the past is striped. But it has some disadvantage. First the patient should have power preparation. Yeah just different from the yes uh from uh stomach access. It may help a retina contam contamination. The patient may have possible abdominal infection and the pace is very far. Sometimes the ontological manipulation is very very difficult. In our center we always use the trans gastric access. So this past I think we always make a entrance access in the less curvature of the interior wall of the engine. The past is very short and uh switching with the capture of the war. I think this technique is major. The mayor has low possibility epidemic a infection. Okay it has some also has some just want the advantage. So the first is a pest is public sometimes no scope is relaxed reflects in the economic cavity. So last year we published our work. Mhm. In the endoscopy Jonah. And this our paper endoscope transmits Zika. Can you tell me a new approach for a million more investable balances to act on it? In china will also perform some those procedures for the girl blood pilot. This patient was The only 18 years old. During from the during from the archer aside there are some one cm pileups within the corporate ladder. The patient wants to keep the gallbladder. So we perform the endoscope transfers trans gastric lumpectomy with a sneer for this young for this girl bled pilot so will sneer. We can use we can remove such relations such pileups with EMR technique. This here is another note department our pancreatic necrosis. I first performed us guided Janet with mm metallic in stand for this patient one month later when when I follow up these patients yes spent disappeared do from the U. S. We think we think we decide that the stent slip into the pancreatic assist. So with no technique I opened I opened the opened in your stomach and put the scope into the have courage since so when we check the her since there was no there was no stand and we just ask it remote remote uh necrotic tissue on the endorsed copy. At last we use the envelope and the clips for calamity that uh entrance. So this is a combination of the U. S. And the notes technique And no technique. The 3rd space I think we used some mucus lee accused lose. Uh huh. Something because space to perform some procedures home fuck. Last year I think is the origin of the super meat tender technique is a milestone of this. I mean because the tender endoscopy we performed our first home case In China in two 1010 August the patient was 60 years old. And the first procedure time of poem is 85 minutes. So recently We report our experience from more than 3000 cases. A pump injunction hospital. So we report our landscape of adverse events related to the problem in three 100 patients and at risk of school system to protect the major adverse event in in this year S. C. G. H. From the tender in those cops 1st. Okay removed last mucosal lesions and the second we can cut the circular muscle and the launch into the muscle. And this is a poem for the class here we can remove the lesions from Mongolia. And this is a standard technique. So with the tender technique we can remove just humor's from muscle layer. I think the procedures is similar to the poem for Malaysia. With a tender technique we can know make some most open area biopsy for unknowing structures. So this patient was a young patient was 16 years old. So yeah, as far as the owners of scripture, the acknowledge is knowing. So with the turner technique we my opposite is a muscle two months earlier. That last attack on this is was limbo lymphoma. With with under biopsy the dark and this is was make clear we performed the actual problem in china for some congenital hypertrophic political status is so this page in the most found in the first six months of the life. The clinical findings are progressive and agree at one meeting with no buyer. Sometimes we can find some Katica paralysis where a phenomenal mess. The patient always have male nutrition dehydration and hyper Colombia are colossus. On the, on the other side you can find the political was very very second. And from the periods war period swelling and and the scope and and the endoscope we can find the contrast and the scope cannot pass through the flores into that Georgina. So, with experience of the palm will not perform. Yeah. Get your poem for for such young patients. Traditional treatment for this young patient surgery. So it was which gets your poem. We can know catches up cutting our second circle uh the muscle in the polaris after the GPA. So just structure can be relieved. So yeah, from the pre operation and opposed operation, we can see that construct contrast handle this rueda dolores very, very fast. And the scope can also through the dinner. So I think the one meeting of the symptoms can be disappeared very very fast. This is my 6th 16th case of the g poem for such young patients. The patient was only 23 days old, not years old. The body wet was only 3.2 kg grips. So the procedure time for this patient was 24 minutes. So we cannot perform such procedures within 30 minutes. So these are my young patients with the people. We're also populist our paper in last year's uh endoscopy, Jonah horrible palermo Tommy for the treatment of the entire hypertrophic political standards is how about actual looms can for in the past we can use the first sickness resection technique. So remove the correlations with the help of the third technique as window. That big advantage was a tender. And that's probably is you can improve yeah, he is the quality of the life. It can decrease the perforation or complications after four sickness resection so that it can improve that patient safety. So with the turner technique now we can make a tender and then with internal cut earlier putting the scope outside of the tender. Then with the exception of operations along the capture of the tumor at the last you several clips to close the entrance of the tunnel. So this is a stir technique for extra not to us. So we first reported this technique in the H. G. In 2016. So this is another interesting case. This patient was 66 years. And during the routine checkup we found as far as open because tumor from the city scanning we find the dilation was actually totally actual aluminum And the legion was about 23 times 19 mm with someone because itinerary we cannot finding the tumor. The leading was not original phenomena mostly in the esophagus. Yeah. I with a circular muscle and launching of the muscle with 18 5. So after that we found that leading the lesion was located in a media stardom. So within the media stardom remote relations with a sneer. Now the legions was or the removed a from that media student from the east figures. So the last yep is similar to the poor. Were used several cliffs to close the entrance. I was a tunnel. So actually this is the third technique for the removal of the excellent no humor. So this patient their second of the the patient in the campaign of the horribleness. So from the endoscopic we find left side of the worker called fixed. But that girl otitis is opening since the last agonizes for this tumor was she wants number. So actually the location was what comes from the recurrent, did you know? No. So in last year's got well, first report transits feature industrial removed. I would have been nine media's there tuner for this uh humor for this case. I think this is a new field for the end of therapy for the cost to trigger something because some are originated from the deep layers. Oh get real war. We cannot use the first industry section technique and still what for some tumors. Sometimes the lesions are usually in the question and position and endoscopic veer from the catcher lumen sometime is very, very poor. And sometimes the tumor is highly movable was limited. And that's it per year. So how to remove how to reserve such difficult of the and those and block resection and homeostasis. A new technique was recently performed in Tongji hospital and document interpreting here subject to rosa dissection was performed. So this is a sometimes mucus tumor origin from the most leah from cT scanning shoot relation was in the excellent growth. So we're first removed relations with the summer because a tendering into industry mucosa layer in the stomach and within the phenomenal cavity. So such serious violations was performed. So this is this is a tumor and we can find from the U. S. And the city scanning the location was in the Sarasa layer. So we performed such procedures first mega turner about 5000 m near near the tumor. Then cut the holy with the stomach. And I put the scope into the seriously we think that uh such a tumorous was successfully I affected and this is dissected security man. So during the follow up we find this is because the incision means the opening of the tender and this area is a tumor site for the endoscopy interpreting near surpass arosa dissection. So first it can maintain the mucus into gravity. So it has less complications. It is a smooth mutual mutual inspection. Makes the easy clue. You always want Distance between the preparation and is alleging about always about five cm. Makes better exposure and the endoscopy step mobilization. So now in this. Yes. D. D. W. Were we report this case this technique in the video plenary section and the court is the best of the best award. So ladies and gentlemen and just before significant resection. And the surgeon technique ear's laid the foundation for the notes. It makes the note thrive. Someone because of tendering techniques. Makes news. Was both indications I think in the future the endoscopy flexible Indus copy is not only operating is that natural orifice but also within and outside the catcher. Uh interested in the world. Recently. I just think of one question. What's the future of the industrial research? How to make the industrial procedures saver faster and simpler. So the indications with the minimum surgery I think are uh not only the age but also the indications is expanded. So it is a real minimal instead uh minimal investable surgery. Compared to the laparoscope it can preserve the organ function. So in the future meaning well investable not earlier for the patients but it should also for the end those copies the technology development for the endoscopy for the endoscopy. I think this market field is becoming very very large. Very very big. That's my presentation. Thanks for your kind of listening. See you in the next live demo. Thank you very much. And. Uh huh. I can visit a long island in the future after the college 19 pandemic. Thank you very much Published August 5, 2021 Created by
