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| Name | Thulium Laser Transurethral resection of the prostate -Vasil Angelov M.D. |
| Video Uploader | Video From Central Hospital Plovdiv-Urologie |
| Upload Date | This Video Uploaded At 08-02-2017 00:49:20 |
| Video Discription | The patient is placed in the lithotomic position. Sterile draping of the patients is prepared while sterile gel is put in the urethra. The resectoscope is inserted, under vision, into the bladder. It is recommendable to perform a cystoscopy in the way to exclude eventually bladder pathologies and to have a look at the ureteral orifices. Finally the resectoscope is pulled back into the prostatic urethra and a detailed evaluation is made of the bladder neck, the extent of lobar protrusion, position of verum montanum and the borders of external urethral sphincter. The enucleation starts with removal of the prostatic median lobe. An inverted U-incision at the level of the verum montanum is placed, to delimitate the distal board of resection. Bilateral bladder neck incisions close to the lateral margins of the prostatic median lobe are made at the 5 and 7 o’clock positions. These incisions are extended until the distal third of the verum montanum, board the entire median lobe. Finally a deeper incision can be made so the surgical capsule can be visible. It is a white layer with superficial small vessels. At this time, it is possible to start the blunt retrograde enucleation of the prostatic median lobe. The enucleation technique is performed with the resectoscope that is used like a retractor, that is pushed and bluntly shifted towards the 12 o'clock direction the median lobe. This action has to be conducted under the edge of the median lobe that is softly separated from the surgical capsule. The surgical capsule is used as a natural cleavage plane, as has been done with an index finger in the open prostatectomy. During blunt disconnection of the adenoma, laser coagulation of perforating vessels of the surgical capsule is necessary and needs to be continued until the bladder neck is gained. When complete disconnection of the median lobe from the surgical capsule is reached, the adenoma can be pushed into the bladder lumen. The lateral lobes are removed separately, beginning with the smaller one if the adenoma is asymmetric. The first incision is made at the distal margin of the adenoma at the 12 o’clock position. From the U-inverted incision, two superficial incisions towards the 4 o'clock (left lobe) and 8 o'clock (right lobe) positions are carried out. The apical board of the lateral lobes is then incised between the incisions at 12 o'clock position and the incision at 4 o'clock or 8 o'clock. At this time the bluntly shifted process can be done in the same way we described for the median lobe, but in this case it is necessary to pull the lateral left lobe towards the 2 o'clock position and the lateral right lobe at 10 o'clock into the bladder lumen. The surgical capsule can be identified by visualizing the white layer and small perforating vessels. It is necessary to coagulate these small vessels and use a 40 W energy until the bladder neck is reached. Again, after complete release from the surgical capsule, the lateral lobe is pushed into the bladder. The same procedure is then identically repeated on the other side. When the entire adenoma has been pushed into the bladder lumen the resectoscope is replaced by a nephroscope adapted for the morcellator. The suction pump attracts the pieces of the adenoma and the blades fragment them. This procedure is done with continuous irrigation and a fully distended bladder to avoid any bladder wall injuries. The procedure ends with a 22 Fr catheter. The catheter was removed after 48 hours from the surgery. Patients were discharged home after a successful voiding trial after the catheter removal. All complications were recorded and blood loss was estimated by hemoglobin blood evaluation 24 hours after surgery. Enucleated tissue was histopathologically evaluated in all cases. |
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