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HOW I DO IT
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Anatomic GreenLight laser vaporization-incision technique for benign prostatic hyperplasia using the XPS LBO-180W system: How I do it
Law W. Kyle, Elterman S. Dean, Cash Hannes, Rijo Enrique, Chughtai Bilal, Misrai Vincent, Zorn C. Kevin, MD Department of Urology, University of Montreal Hospital Center CHUM, Montreal, Quebec, Canada
For men experiencing lower urinary tract symptoms (LUTS) refractory to medical therapy, there have been numerous developments in the treatment options offered for benign prostatic hyperplasia (BPH) in the recent years. Transurethral resection of the prostate (TURP) has remained the reference standard for men with prostates sized 30 cc-80 cc, while open prostatectomy is universally guidelines-recommended in the absence of enucleation, for men with prostates larger than 80 cc-100 cc. While these techniques are effective, they have the potential for bleeding complications requiring transfusions, electrolyte abnormalities such as TURP syndrome, and often require prolonged hospitalization. GreenLight photoselective vaporization (GL-PVP) with the XPS LBO-180W system offers a minimally invasive treatment that can be carried out on essential any sized prostate gland. In addition, the GL-PVP procedure can be done as a same day discharge surgery requiring no overnight hospital admission and allows patients to continue any necessary anti-coagulants given the significantly reduced risks of bleeding complications or TURP syndrome. In 2005, the anatomic vaporization-incision technique (VIT) using the XPS LBO-180W system was described to address larger prostate volumes. VIT combines principles of traditional GL-PVP and enucleation techniques to identify the reference surgical capsule early-on into the surgery and resect portions of prostate adenoma without the need for tissue morcellation. Early studies comparing anatomic VIT to standard PVP outcomes demonstrated significant improvements of IPSS and uroflowmetry parameters, along with statistically significant greater PSA reduction at 6 months, particularly in prostate volumes greater than 80 cc. The objective of this article is to detail our surgical approach to the anatomic GreenLight laser vaporization-incision technique using the XPS LBO-180W system, based on extensive personal experience with both enucleation and vaporization techniques using various laser technologies. Standardization of the VIT based on proper cystoscopy, knowledge of prostate anatomy with preoperative ultrasound, and routine technique is essential to developing consistent, reproducible and optimal surgical outcomes.
Keywords: benign prostatic hyperplasia, lower urinary tract symptoms, vaporization-incision technique,
Oct 2019 (Vol. 26, Issue 5 , Page 9963)PDF (1.12MB)Free -
How I do it: Aquablation of the prostate using the AQUABEAM system
MacRae Catriona, Gilling Peter, MD Department of Urology, Tauranga Hospital, Tauranga, New Zealand
Benign prostatic hyperplasia (BPH) represents one of the most common conditions encountered in urological practice. For many years, transurethral resection of the prostate (TURP) has been considered the gold standard for surgical management of symptoms in prostates of 30 cc-80 cc. Although TURP provides excellent functional outcomes, there is significant morbidity associated with the procedure, particularly with regards to bleeding, electrolyte imbalance and sexual dysfunction. Emerging technologies aim to maintain the excellent functional results of TURP whilst decreasing the adverse events experienced by the patient. Aquablation is a novel therapy using a high-velocity waterjet and real-time ultrasound imaging with robotic assistance for targeted removal of prostate tissue. We present our experiences with this new technique, the equipment required and steps involved.
Keywords: benign prostatic hyperplasia, transurethral resection of prostate, ablation techniques, aquablation, bladder outlet obstruction,
Dec 2016 (Vol. 23, Issue 6 , Page 8590) -
How I do it: prostate cryoablation (PCry)
da Silva Donalisio Rodrigo , Jaworski Paulo , Gustafson Diedra , Nogueira Leticia , Molina Wilson , Kim J. Fernando, MD Denver Health Medical Center/University of Colorado Cancer Center, Denver, Colorado, USA
Prostate cryoablation (PCry) is a well-established minimally invasive therapy for the treatment of prostate cancer. Unfortunately, PCry still carries the stigma of a high rate recto-urethral fistula procedure but with the advent of argon/helium gas technology, urethral warmer and high quality transrectal ultrasound imaging, complications decreased and efficacy increased. The Denver Health Medical Center's technique in prostate cryoablation is described as follows.
Keywords: technique, prostate cryoablation,
Apr 2014 (Vol. 21, Issue 2 , Page 7251) -
Use of blunt right angles to aid in intussusception of a Bricker ileal conduit
Strigenz E. Michael , Uhlman A. Matthew , Brown A. James, MD University of Iowa, Iowa City, Iowa, USA
The Bricker ileal conduit has been the most popular urinary diversion technique following a radical cystectomy since the 1950s. The procedure typically provides a high quality of life for patients. However, stomal complications occur in 16%-65% of ileal conduit cases. We describe an easy technique to aid in the intussusception of a Bricker ileal conduit. This technique produces stomas with a height of 2 cm-3 cm consistently. In our experience, we have had excellent results when using this technique.
Keywords: surgical techniques, ileal conduit, surgical stoma, urinary bladder neoplasms, cystectomy,
Feb 2014 (Vol. 21, Issue 1 , Page 7171) -
Robot assisted radical prostatectomy: how I do it. Part II: surgical technique
Valdivieso F. Roger , Hueber Pierre-Alain , Zorn C. Kevin, MD Hopital St. Luc Montreal, Quebec, Canada
The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.
Keywords: surgical techniques, prostate cancer, robot assisted radical prostatectomy,
Dec 2013 (Vol. 20, Issue 6 , Page 7073)
