Thursday, February 17, 2011

More visitors... this time from Spain

This week we were honored by the visit of colleagues from Hospital Fundación Jimenez Díaz, Madrid, and Hospital Rio Hortega, Valladolid.

I showed them how the new GreenLight XPS allows to perform a good prostatectomy even in very large prostates.

The last case was quite impressive. The patient had a very big prostate and was a high risk surgical candidate. He had a giant intravesical median lobe. We applied a mixed technique, vaporizing first the anterior and lateral part of the adenoma with a Moxy fiber, that allows to work at 120 watts, vaporizing very fast. I took a lot of care in  preparing very well the area near the urinary sphincter, and then we proceeded to enucleate all the median lobe with a 2090 fiber, more resilient to mechanical force and ideal for enucleation. We worked at 80w-vap/40w-coag to enucleate the median lobe. After it floated freely in the bladder we extracted it with the Piranha morcellator from Wolf. I think we extracted about 60 grams of tissue... and at the end of the procedure we had used 500.000 joules. This mixed technique, using vaporization first and enucleation next is very interesting, because enucleating the median lobe after the vaporization of the lateral and anterior tissue is a piece of cake.

On the ohter hand, this type of technique would allow many surgeons who use GreenLight to face bigger prostates with better results, and it is not as difficult as the complete enucleation of the adenoma. Maybe also this initial preparation of the sphincter allows for a very low rate of sphincteric continence.

The following photos illustrate the completeness of the procedure.

Pre and postoperative transrectal ultrasound, longitudinal view

Pre and postoperative transrectal ultrasound, transverse view

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