Commentary

 

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Presealing of vessels during underwater third-space endoscopy is vital because bleeding may cause visual field loss [1]. Capogreco et al. present a novel technique in which flushing around the tip of the knife enables the presealing that effectively prevents intraprocedural bleeding, without the sparking that indicates an undesired cutting effect [2]. Notably, this method resulted in minimal bubble formation after presealing.

However, when cutting was desired, a relatively weak flush has been associated with less bubbling than no flush, reducing the risk of bubble-induced visual field impairment while preserving the cutting effect [3]. The difference between these two phenomena suggests that bubble formation is associated with electrocautery discharge. The bubbles may contain vapor [4] and possibly hydrogen [5] generated by intracellular fluid electrolysis [6]. Despite these findings, the specific role and impact of flushing during underwater third-space endoscopy requires further investigation.

Publication History

Article published online:
27 June 2025

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