GREENLIGHT XPS - STEP 4 - DR. ZORN - HOW I DO IT 2014 скачать в хорошем качестве

GREENLIGHT XPS - STEP 4 - DR. ZORN - HOW I DO IT 2014

As with any surgical procedure, the use a standardized approach will ensure reproducible outcomes. Following a pathway allows the surgeon a template recipe to approach all the variables that one may encounter during surgery. The following video summary series will take the surgeon through the same 9 step format I follow during Greenlight XPS prostate surgery for the treatment of male BPH. In step 4, the laser Storz scope is rotated to 9 oclock to allow the XPS fibre to exit at 3 o'clock on the screen. This allows the surgeon the ability to assess the anterior commissure and begin incision at 120 W through the 1 o'clock tissue. Shorter, straight pull backs of the fibre are recommended to ensure a more controlled "cut" through the tissue to identify the surgical capsule. Care must be made not to come back too far and possibly injure the anterior exterior sphincter. The surgeon should also be aware that between the 9'- and 3'- o'clock positions along the surgical capsule, the capsule is thin and behind the capsule is the dorsal venous capsule. This is different than the floor insofar that there exists the posterior zone of the prostate as a buffer zone. As such, care must be made to avoid perforation of the capsule anteriorly - hence 120W max power and faster movements with the fibre to simply "cut down to the capsule. Once the surgeon identifies the capsule, the angle of the XPS fibre can be slowly rotated to aim at the junction of the left lateral lobe adenoma and the capsule. This repetitive motion helps cleave-off or begin enucleating the the adenoma off the capsule. Personally, although challenging for the new-comer, it is the most visually-enjoyable moves of the case. It is always impressive how as urologists, we underestimate the volume of BPH adenoma tissue anteriorly. It is for this reason, retreatment of BPH surgery is typically from anterior and apical tissues. The purpose of releasing off the adenoma anteriorly, which actually takes just a few minutes to do, sets up the more powerful 180 W vaporization and/or vaparoresection of the large tissue mass. Again, this allows the surgeon full and safe access to the adenoma either from directly above or from beneath, all during which the capsule location is known. Once the adenoma is taken down to the capsule, the energy is delivered tangential to the capsule to enucleate in that plane until around 3 o'clock. After which, I like to return to near the verumontanum and deepen the horse-shoe sphincteric marking we did in step 1 down the the capulse. I simply park the scope to see the verumontanum and rotate the XPS fibre slowly rotate. The goal is to join the 5'- o'clock incision to the released plane at 3'- o'clock. Even as i rotate the fibre, I even use the tip of the fibre to push the adenoma forward to protect the urinary sphincter. In summary, this video highlights the key aspects of "RELEASING THE LEFT LATERAL LOBE BY 1' O'CLOCK INCISION", from bladder neck to verumontanum.