• Gentle on blood vessels, nerves and organs
  • Minimized bleeding, controlled management of bleeding
  • High degree of tissue selectivity during preparation and dissection of tissue layers
  • Needleless high-pressure elevation to create a fluid cushion
  • Good visibility at the operative site due to integrated irrigation and suction
  • Saves time overall in the OR

ESM 2 suction module

  • The type of activation and the degree of suction of the ESM 2 are adjusted via the interface of the ERBEJET 2
  • Activation occurs either simultaneous to the application of the waterjet
  • The suction pump can be programmed to continue running for a certain time after waterjet is no longer activated.
  • Good visibility of the target tissue

Hydrosurgery has been successfully used in medicine for many years. Tissue structures are dissected selectively and gently by waterjet. Blood vessels and nerves remain intact up to a certain pressure. Thereafter, vessels may be treated according to with their size. Waterjet elevation can also be used to create fluid cushions in the tissue and to separate anatomical layers from one another.


Injection on demand: No need for instrument exchange
High pressure needle-free injection:

  • Tissue-selective hydrodissection defines tissue planes and creates a protective saline cushion which mitigates unintended thermal damage

Cut and coagulate with proprietary voltage and spark control:

  • Power Dosing automatically deliver slowest effective and adjusted power output in all modes including both CUT and COAG
  • Spark Recognition automatically detects the formation of micro-electric arcs
    (sparks) for controlled and reproducible cuts, e.g. length and quality

The following types of probes are available:

HybridKnife in Urology

The bladder tumor can be resected in one piece using the electrosurgery function of the HybridKnife instrument. By elevating the mucosa, the resection level is raised and the risk of perforation of the muscularis is reduced. The en bloc technique permits a more accurate pathological evaluation after the resection. Complete removal of the tumor can be verified on the basis of a contiguous resection border in the healthy tissue. The prospective, randomized multicenter study will confirm whether the new method has advantages over the gold standard with respect to:

  • improved pathological assessment
  • ability to assess the tumor invasion (lateral and vertical extension of the tumor, R status)
  • improved substaging of T1 tumors
  • initial statements on recurrence and progression rates

Prior to elevation, the tumor is marked around in a circle with coagulation points, which also represent the later line of resection. The
lateral safety margin to the border of the tumor is about 5–7 mm.

Using the waterjet function, the tumor is elevated by injecting within the marked points. The separation medium accumulates in the submucosa
and forms a safety margin to the muscularis. This reduces the risk of perforation during the following resection.

The tumor is resected after cutting around it at the raised resection level. The modes DRY CUT® or ENDO CUT® Q provide a high-quality
cut with optimal hemostasis. Repeating the elevation provides a good presentation of the cut level (beneath the tumor) and contributes
towards achieving the desired R0 resection.

Post coagulation
Vessels or seeping bleeding occurring during or after the resection can be coagulated with FORCED COAG®.

HybidKnife in Peroral Endoscopic Myotomy
The multifunctional HybridKnife instrument not only supports the POEM procedure, it also simplifies the relevant steps. Thanks to the
integrated electrosurgical and waterjet functions, both the time and effort required for surgery is reduced

1. Mucosa elevation|
The mucosa is lifted above the initial esophageal stenosis at the 2 o’clock position (alternative: 5 o’clock). As a result of the high-pressure waterjet elevation, layer-specific accumulation of the separation medium occurs beneath the mucosa, creating a submucosal cushion.

2. Mucosa incision
Using the electrosurgical function of the HybridKnife, the mucosa is opened to a length of approximately 2 cm at around 5 cm above the

3. Creation of a submucosal tunnel
While alternating between the waterjet and the electrosurgical function of the HybridKnife, a submucosal tunnel is created. Thanks to the high-pressure waterjet, a protective layer is established to the mucosa which protects it from mechanical and thermal damage. The tunnel is prepared to approximately 2 cm below the gastroesophageal junction.

4. Myotomy
Using the HybridKnife, a myotomy is then performed of the sphincter, beginning at around 3 cm below the location of the incision up to approximately 2 cm beneath the gastroesophageal junction. Possible bleeding can be immediately coagulated using the HybridKnife.
Following the myotomy, the cut is covered using the intact mucosa and the incision location closed using clips

Monopolar Applicator with combined Waterjet surgery and electrosurgery functions

  • Combination function of waterjet with electrosurgery
  • Faster dissection, shorter operating times, fewer clips required
  • Less bleeding, less need for blood transfusions
  • Good visibility of the target tissue
  • Lower lateral heat generation preserves the adjacent tissue