Láser resección transuretral prostática: estudio de seguridad con un nuevo sistema de fotovaporización selectiva con láser de diodo de alta intensidad en próstatas mayores de 80 ml / Laser transurethral resection of the prostate: Safety study of a novel system of photoselective vaporization with high power diode laser in prostates larger than 80 mL

Objetivo: Presentar la viabilidad de la vaporización fotoselectiva de la próstata (VFP) con un nuevo sistema de resección de láser de diodo. El tratamiento quirúrgico de la hiperplasia prostática benigna (HPB) está en constante evolución. Las técnicas de láser se utilizan cada vez más en próstatas de gran tamaño. Métodos: Se realizó un estudio prospectivo para evaluar los datos operativos y los resultados de los pacientes con VFP utilizando láser de diodo de alta potencia (DAP) y una innovadora fibra con cabeza de cuarzo en forma de pala en los pacientes con próstata > 80 ml. Se describen los datos demográficos, tiempo quirúrgico, pérdida de hemoglobina, resultados operatorios (IPSS, calidad de vida [CdV], Qmáx, residuo posmiccional [RPM], IIEF-5 y micción diaria) y las complicaciones de la clasificación Clavien-Dindo. Resultados: Treinta y un pacientes fueron incluidos en el estudio. Dieciséis (51,6%) estaban en tratamiento antiplaquetario activo y 12 (38,7%) habían recibido anticoagulantes antes de la cirugía. Todos los casos fueron seguidos al menos 6 meses. No se produjeron complicaciones graves intraoperatorias ni postoperatorias. Tres pacientes (9,7%) tuvieron complicaciones leves según la clasificación Clavien-Dindo. Veintisiete (87,1%) fueron dados de alta en el primer día del postoperatorio sin catéter. Hubo mejoras significativas en el IPSS, CdV, Qmáx y RPM, tanto a los 3 como a los 6 meses (p < 0,0001), pero la función sexual según el IIEF-5 no mostró diferencias. La urgencia (de cualquier grado) aumentó a los 3 meses (48,4%; p = 0,002) y se redujo considerablemente a los 6 meses (9,7%, p < 0,0001). Conclusión: Esta experiencia piloto con fibra en forma de pala y DAP es alentadora. Esto demuestra que la resección con láser es un procedimiento seguro, logrando excelentes resultados en cuanto a IPSS, CdV y Qmáx en próstatas grandes, incluso en pacientes de alto riesgo. Se necesita un seguimiento más prolongado, estudios controlados comparativos y aleatorios para generalizar estos resultados

Objective: To present the feasibility of photoselective vaporization of the prostate (PVP) with of a new diode laser-resection system. Surgical treatment of benign prostatic hyperplasia (BPH) is constantly evolving. Laser techniques are increasingly used in prostates of large size. Methods: A prospective study was performed to evaluate operative data and patient outcomes with PVP using high-power diode laser (HPD) and a novel quartz-head fiber with shovel shape in patients with prostate > 80 mL. Demographic data, operative time, hemoglobin loss, operative results (IPSS, quality of life (QoL), Qmax, post void residue (PVR), IIEF-5 and micturition diary) and complications following Clavien-Dindo classification are described. Results: Thirty-one patients were included in the study. Sixteen (51.6%) were on active antiplatelet treatment and 12 (38.7%) had received anticoagulants before surgery. All cases were followed at least 6 mo. No intraoperative or postoperative major complications occurred. Three patients (9.7%) had minor complications according to Clavien-Dindo classification. Twenty-seven (87.1%) were discharged on postoperative day one without catheter. There were significant improvements in IPSS, QoL, Qmax and PVR, both at 3 and 6 mo (P < .0001), but sexual function according to IIEF-5 showed no differences. Urgency (any grade) increased at 3 mo (48.4%; P = .002) and considerably decreased at 6 mo (9.7%;P < .0001). Conclusion: This pilot experience with shovel shape fiber and HPD is encouraging. It shows that laser-resection is a safe procedure, achieving excellent results in terms of IPSS, QoL and Qmax in large prostates even in high-risk patients. Longer follow-up, comparative and randomized controlled studies are needed to widespread these results

Laser transurethral resection of the prostate: Safety study of a novel system of photoselective vaporization with high power diode laser in prostates larger than 80mL.

OBJECTIVE: To present the feasibility of photoselective vaporization of the prostate (PVP) with of a new diode laser-resection system. Surgical treatment of benign prostatic hyperplasia (BPH) is constantly evolving. Laser techniques are increasingly used in prostates of large size. METHODS: A prospective study was performed to evaluate operative data and patient outcomes with PVP using high-power diode laser (HPD) and a novel quartz-head fiber with shovel shape in patients with prostate>80mL. Demographic data, operative time, hemoglobin loss, operative results (IPSS, quality of life (QoL), Qmax, post void residue (PVR), IIEF-5 and micturition diary) and complications following Clavien-Dindo classification are described. RESULTS: Thirty-one patients were included in the study. Sixteen (51.6%) were on active antiplatelet treatment and 12 (38.7%) had received anticoagulants before surgery. All cases were followed at least 6mo. No intraoperative or postoperative major complications occurred. Three patients (9.7%) had minor complications according to Clavien-Dindo classification. Twenty-seven (87.1%) were discharged on postoperative day one without catheter. There were significant improvements in IPSS, QoL, Qmax and PVR, both at 3 and 6mo (P<.0001), but sexual function according to IIEF-5 showed no differences. Urgency (any grade) increased at 3mo (48.4%; P=.002) and considerably decreased at 6mo (9.7%; P<.0001). CONCLUSION: This pilot experience with shovel shape fiber and HPD is encouraging. It shows that laser-resection is a safe procedure, achieving excellent results in terms of IPSS, QoL and Qmax in large prostates even in high-risk patients. Longer follow-up, comparative and randomized controlled studies are needed to widespread these results.

Virtual reality simulator for training on photoselective vaporization of the prostate with 980 nm diode laser and learning curve of the technique.

OBJECTIVE: The utility of a virtual reality simulator for training of the photoselective vaporization of the prostate with diode laser was studied. MATERIAL AND METHOD: Two experiments were performed with a simulator (VirtaMed AG, Zürich, Switzerland) with software for specific training in prostate vaporization in contact mode with Twister fiber (Biolitec AG, Jena, German). Eighteen surgeons performed ablation of the prostate (55 cc) twice and compared the score obtained (190 points efficacy and 80 safety) in the second one of them by experience groups (medical students, residents, specialists). They also performed a spatial orientation test with scores of 0 to 6. After, six of these surgeons repeated 15 ablations of the prostate (55 and 70 ml). Improvement of the parameters obtained was evaluated to define the learning curve and how experience, spatial orientation skills and type of sequences performed affects them. RESULTS: Global efficacy and safety score was different according to the grade of experience (P=.005). When compared by pairs, specialist-student differences were detected (p=0.004), but not specialist-resident (P=.12) or resident-student (P=.2). Regarding efficacy of the procedure, specialist-student (p=0.0026) and resident-student (P=.08) differences were detected. The different partial indicators in terms of efficacy were rate of ablation (P=.01), procedure time (P=.03) and amount of unexposed capsule (p=0.03). Differences were not observed between groups in safety (P=.5). Regarding the learning curve, percentage median on the total score exceeded 90% after performing 4 procedures for prostates of 55 ml and 10 procedures for prostate glands of 70 ml. This course was not modified by previous experience (resident-specialist; P=.6). However, it was modified according to the repetition sequence (progressive-random; P=.007). Surgeons whose spatial orientation was less than the median of the group (value 2.5) did not surpass 90% of the score in spite of repetition of the procedure. CONCLUSION: Simulation for ablation of the prostate with contact diode laser is a good learning model with discriminative validity, as it correlates the metric results with levels of experience and sills. The sequential repetition of the procedure on growing levels of difficulty favors learning.