Usefulness of the maXium high-frequency surgical device in colorectal EMR.

Abstract

Purpose: High-frequency surgical devices with various functionalities are widely used in Europe and Japan. In this study, we evaluated the effectiveness of the maXium HF surgical device manufactured by KLS Martin (Germany) during endoscopic mucosal resection (EMR).

Materials and methods: The maXium device offers multiple preconfigured modes for incision and coagulation tailored to different surgical procedures. Endoscopists can intuitively select the appropriate mode using icons on the front panel. For polypectomy and EMR, the device uses the Polyp I/II mode, which alternates between incision and coagulation waves. This mode is characterized by a relatively short incision wave duration, even at increased power settings. During polypectomy and EMR, incomplete coagulation of vessel margins may occur if a vessel is resected in a single pass with excessive clamping, potentially leading to post-procedural bleeding. We examined the number of incision wave applications and hemostatic interventions performed prior to resection in 110 colorectal lesions from 35 patients who underwent polypectomy or EMR at our institution between August and December 2018 using the maXium device. Hemostasis was achieved using radiofrequency coagulation via hemostatic forceps and snare tips.

Results: The 110 resected lesions were classified as follows: 8 lesions were type Ip, 23 were type Isp, 59 were type Is, and 20 were type IIa. Lesion sizes were categorized as 0-5 mm (24 lesions; mean energizations: 2.1; hemostatic interventions: 2/24, 8%), 5-10 mm (72 lesions; mean energizations: 2.6; hemostatic interventions: 4/72, 5%), 10-15 mm (11 lesions; mean energizations: 2.8; hemostatic interventions: 2/11, 18%), and 15-20 mm (2 lesions). Resection was achieved in a single incision wave in 8 cases (7.8%). No cases of delayed hemorrhage or perforation were observed. The number of lesions resected with a single current application during EMR was relatively low.

Conclusion: Due to its low incidence of intraoperative bleeding, the maXium device demonstrates significant utility for EMR, a procedure commonly performed in routine clinical practice.