Post on 01-Apr-2015
GREENLIGHT LASER PROSTATECTOMY
PROCEDURAL TECHNIQUE
Dr Charles Chabert
GLP Technique
Basic principles
Modular approach (IGLU)
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Key Points
Being familiar with fibre landmarks
Working distance
Rotation speed
Vaporisation & Coagulation
Charles Chabert
Learning GreenLight
Proficiency with the basic procedure is typically achieved in approximately 10 cases
After the first 10 cases you can expect toReduce OR and laser time
Progress to larger glands
Treat patients who may be on anticoagulants
Treat patients with additional co-morbidities
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Identify Fiber Markings5
The triangle on the cap is 180degrees from where the laser beam fires
The red stop sign is aligned with the aiming beam of the fiber
Charles Chabert
Fibre Landmarks
Charles Chabert
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Aiming Beam
Before firing the laser, the laser aiming beam and fiber cap must be clearly visible through the cystoscope
The red aiming beam indicates the location of where the laser energy will be directed.
Caution: Do not fire thelaser unless you cansee the red aiming beamon the targeted tissue
Tissue
Charles Chabert
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Laser Deflection Angle
Be aware that the laser exits at a 70° forward deflection angle to the fiber axisNote: Use caution when treating tissue at
the bladder neck to avoid damage to ureteral orifices or trigone / bladder
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Fiber Handling
The Blue Triangle must be visible under cystoscopic view or inner sheath damage may result.
Don’t pull back Wrong directionCorrect direction
Charles Chabert
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Laser Tissue Interaction
Depends on the following parameters:
Tissue composition
Laser wavelength
Power / energy settings
Mode of laser operationVaporization vs Coagulation
Fiber handling technique
Charles Chabert
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Distance to Tissue
1.8 mm
≤ 3.0 mm
Visual Clue: work 1 fiber cap width from tissue
Optimal working distance to tissue is 0.5 to 3.0 mm
Charles Chabert
Results/Benefits:• Collimated beam makes tissue removal rate is insensitive to fiber-to-tissue
spacing over the 1 – 3 mm operating range• Faster procedures without requiring unrealistic control of fiber position• Less chance of unintentional coagulation • Larger fiber to tissue distance leads to cleaner fibers and longer fiber life.
Why Does A Collimated Beam Matter?
Charles Chabert
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Speed of Tissue Vaporization
Bubbles indicate vaporization efficiency
To increase vaporization:Slow sweep speed Check distance from tissue (near contact)Increase power
To slow down vaporizationIncrease sweep speedDecrease power
Charles Chabert
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Proper Sweeping Speed
Correct = Vaporization Incorrect (too fast) = Coagulation
Charles Chabert
MODULAR TECHNIQUE:
INTERNATIONAL GREENLIGHT LASER USERS (IGLU)
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Key Steps
1. Insertion of cystoscope
2. Creation of working channel
3. Vaporisation of lateral lobes
4. Median lobe & bladder neck
5. Completion & IDC insertionCharles Chabert
Introduction of Cystoscope
Charles Chabert
CREATION OF A WORKING CHANNEL
Charles Chabert
Modular Approach
Charles Chabert
Median Lobe
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Bladder Neck
Charles Chabert
Completion of procedure
Assess Haemostasis
Insert IDC
Flush out bladder debris
Timing of TOV
Charles Chabert
Acknowledgements
International GreenLight Users group
Charles Chabert