GREENLIGHT XPS - STEP 1 - DR. ZORN - HOW I DO IT 2014 скачать в хорошем качестве

GREENLIGHT XPS - STEP 1 - 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 1, upon initial cystoscopic entry with the 23F Storz laser resectoscope, care is made to avoid mucosal trauma. This involves not torquing on the bladder neck or median lobe just to visualize the ureteral orfices. This is a common mistake and lends to unnecessary bleeding early during the case. Anatomic referencing (orfice location, bladder trabeculation and diverticulum, bladder stones) should be performed prior to surgery with flexible cystoscopy. Similarly, I highly advocate the use of trans-rectal ultrasonography to accurately measure prostate volume (PV). PV plays a huge relationship to total operative time, energy use, complications - all of which affect surgeon focus and patient conselling. We have recently published on the accuracy of PV with TRUS (Bienz M, et al. http://www.ncbi.nlm.nih.gov/pubmed/24.... The direct relationship of PV to operative outcomes was published in our multi-institutional, global outcomes paper by Hueber et al. (http://www.ncbi.nlm.nih.gov/pubmed/24.... In the following video, note that the initial aspect of the surgery is the protective marking of the apical margin of the prostate. Use of the coagulation mode of the XPS Greenlight, a horse-shoe marking is made just behind the verumontaum. That way, during retrograde sweeping of the laser fibre during adenoma vaporization, the surgeon has a visual cue (typically on the contralateral side) to ensure no sphincteric injury. Such a simple error could lead to deleterious outcomes (stricture, incontinence). Simple idea - however powerful protection for the urologist. Next, at the basic power setting of 80W, the surgeon should vaporize the lateral kissing walls to open up the prostatic fossa. This would be done with slow vaporization (0.5 Hz) from the bladder neck to the verumontanum to make the CONCAVE prostatic fossa (kissing lobes) to an open CONVEX space. This will allow for better water flow and visualization of tissue. With the vascular mucosa, lower power 80W is strong enough to produce good vaporization. At the same time, with limited working space is occasional bilobar prostates, lower power is great to minimize fibre damage from tissue contact. In summary, this video highlights the key aspects of "MARKING THE SPHINCTER AND MAKING SPACE".