RESUMO
The 980 nm/1470 nm diode laser represents the latest in laser technology for photovaporization of the prostate. Surgeons have already used this device in both inpatient and outpatient (office and ASC) setting to produce transurethral resection of the prostate (TURP) like lesions-albeit with fewer complications than traditional methods. The objective of this article is to report the techniques we used to demonstrate its efficacy and safety of the Evolve Dual (biolitec Inc., East Longmeadow, MA, USA) system in an outpatient surgery type setting.
Assuntos
Sedação Consciente , Terapia a Laser/métodos , Lasers Semicondutores/uso terapêutico , Hiperplasia Prostática/cirurgia , Prostatismo/cirurgia , Ressecção Transuretral da Próstata/métodos , Acetaminofen , Adjuvantes Anestésicos , Assistência Ambulatorial/métodos , Anestesia Local , Anestésicos Locais , Diazepam , Combinação de Medicamentos , Humanos , Terapia a Laser/instrumentação , Lidocaína , Masculino , Oxicodona , Hiperplasia Prostática/complicações , Prostatismo/etiologia , Ressecção Transuretral da Próstata/instrumentaçãoRESUMO
BACKGROUND AND PURPOSE: Urologic resectoscope loops often are manipulated to reposition the angle. The effects of these maneuvers on the efficiency and functionality of the loop have never been tested. Our goal was to evaluate the changes in tensile strength, conductivity, and dispersion of cautery effect resulting from such manipulation. MATERIALS AND METHODS: Resectoscope loops manufactured by Karl Storz, Olympus, Boston Scientific, and ACMI were tested for tensile strength and unevenness of cautery effect before and after one manipulation from an angel of 15 degrees posterior to 15 degrees anterior deviation. RESULTS: Prior to manipulation, the loops demonstrated a tensile strength of approximately 40 lb to failure. After one manipulation, the tensile strength was reduced by 90.1% (P < 0.001), with 46.7% of the loops failing to meet minimum industry standards. Manipulation of the loops increased the resistance to current flow within the wire. Microscopic evaluation showed longitudinal fracture lines at the manipulated sites. CONCLUSION: Physician-manipulated resectoscope loop angles have a dramatic effect on the strength of the loop as well as the dispersion of energy. A bend of 30 degrees results in 46.7% of the loops failing to meet minimum tensile-strength standards and alters the effectiveness and dispersion of electrical current. Infrared photography confirms the defect to be generated at the point of manipulation, thereby reducing the anticipated capabilities at a constant setting of the loop energizer. Ultimately, the quality of surgical resection suffers from even one manipulation of a resectoscope loop.
