Tratamiento de la hipertrofia benigna de próstata con el láser Revolix® / Treatment of benign prostatic hyperplasia with the Revolix® laser

Objetivo: El tratamiento de la hipertrofia prostética benigna (HBPj mediante el láser Revolix® es eficaz y seguro. Su versatilidad permite la utilización de dos tipos de técnicas: la vaporesección y la vaporización. Su target cromóforo es el agua, como sucede con el láser Holmiun, con la diferencia que se puede utilizar a modo continuo y a modo pulsado. La onda continua permite realizar cortes precisos y excelente hemostasia sin afectar a los tejidos vecinos (0.2 mms de penetración debajo del corte) con una excelente visión del campo operatorio. Presentamos nuestra experiencia después de 3 años de tratamiento. Métodos: El láser Revolix® (Thulium) tiene una longitud de onda de 2013 nm. Se utilizan dos tipos de fibras para tratar la HBP que alcanzan hasta una potencia de 70 vatios. Una fibra frontal para la vaporesección y una fibra con emisión de energía láser lateral para la vaporización. Ambas fibras pueden combinarse para tratar la hipertrofia prostática. Desde finales del 2004 hasta marzo del 2008 se trataron 200 pacientes por HBP. Los tamaños de las próstatas oscilaron entre 20 y 120 grs (promedio 45grs). Se realizó vaporización de la próstata en 99 pacientes, con tamaño menor de 35 gramos, y se hizo vaporesección en 101 pacientes, cuyas próstatas eran mayores de 35 gramos. El tiempo medio de hospitalización fue de 24 horas (rango 1-4 dias). El tiempo medio de permanencia de la sonda de Foley tras el tratamiento con láser fue de 16 horas (rango 12-72 horas). La efectividad del tratamiento de la próstata mediante el láser Revolix® fue evaluada principalmente con la flujometria, midiendo el residuo postmiccional y evaluando la sintomatología mediante el cuestionario IPSS. Resultados: Los resultados clínicos obtenidos tras operar a los pacientes con HBP mediante el láser Revolix® son comparables a los que se obtienen con la resección transuretral de próstata, la vaporización con KTP ó la enucleación con láser Holmium. Se demuestra una importante mejoría de los síntomas, con una diminución de más del 50% del IPSS, un aumento significativo en la flujometría y un marcado descenso del residuo postmiccional. No se precisó hacer ninguna transfusión sanguinea. Hubo solamente 4 pacientes que presentaron retención aguda de orina postoperatoria, que requirieron colocación de sonda vesical durante unos días, recuperando la micción espontánea posteriormente. No hubo ningún paciente que presentara incontinencia urinaria tras el tratamiento con el láser Revolix®. Conclusiones: En nuestra experiencia, el láser Revolix® ha demostrado ser muy seguro, de fácil instalación, con bajo costo operativo y con una curva de aprendizaje muy corta. Su efectividad se puede poner más de manifiesto empleando la vaporesección en las próstatas voluminosas y la vaporización en las próstatas más pequeñas (menores de 35 grs). La reducción del tejido prostático es inmediata con un ligero desconfort post operatorio y un bajo índice de complicaciones (AU)

Objectives: The treatment of benign prostatic hyperplasia (BPH) with the Revolix® laser is effective. Its versatility enables 2 types of techniques: vaporresection and vaporization. Its chromophore target is water, like the holmium laser, with the difference that it may be used in both a continuous and pulsed mode. The continuous wave enables a precise cut and excellent hemostasis without diffusion to the neighbour tissues (0.2 mm penetration below the cut zone) with an excellent vision of the operative field. We report our experience after three years of treatment. Methods: Revolix® (thulium) laser has a wavelength of 2013nm. 2 types of fibers, which reach a potency of up to 70 watts, are used to treat BPH. One frontal fiber for vaporresection and one fiber with side laser emission for vaporization. Both fibers may be combined to treat prostatic hypertrophy. Since the end of 2004 to March 2008 200 patients with BPH were treated. Prostate sizes varied from 20 to 120 g (mean 45 g). 99 patients underwent prostate vaporization, with sizes below 35 g, and 101 patients underwent vaporresection, with prostates over 35 g. Mean hospital time was 24 hours (range 1-4 hours). Mean catheterization time after laser treatment was 16 hours (range 12-72 hours). The efficacy of the treatment was evaluated with uroflowmetry, post void residual and evaluation of the symptoms with the IPSS questionnaire. Results: The clinical results obtained after Revolix® laser are comparable to those obtained after transurethral resection of the prostate, KTP laser vaporization or holmium laser enucleation. We demonstrate an important improvement of symptoms, with a decrease over 50% in the IPSS score, a significant improvement in the uroflowmetry, and a marked decrease of post void residual. No blood transfusions were required. There were only 4 patients that presented post operative acute urinary retention, requiring catheterization for a few days; all of them achieved spontaneous voiding posteriorly. No patient presented urinary incontinence after treatment with the Revolix® laser. Conclusions: In our experience, the Revolix® laser has demonstrated being safe, easy to install, with low operative cost, and a very short learning curve. Its efficacy may be better demonstrated using vapor resection for big prostates and vaporization for smaller prostates (the smaller than 35 g). The reduction of prostatic tissue is intermediate with a slight post operative discomfort and a low complication rate (AU)

¿Qué aporta el láser Revolix® en las nefrectomías parciales? / What does Revolix® laser contribute to partial nephrectomy?

Objetivo: La nefrectomía parcial es una técnica que requiere una manipulación extensa y un control de la vascularización renal. En el presente trabajo evaluaremos la aportación del láser Revolix® en la cirugía renal minimamente invasiva y conservadora de nefronas durante los años 2005-2008. Métodos: Hemos utilizado el láser Revolix® (Thuliumj que es un láser con una longitud de onda de 2013 nm , dentro de los infrarojos (invisible) que actúa de forma continua y pulsada. Su target cromóforo es el agua. Pueden utilizarse dos técnicas diferentes: la vaporización (fibra lateral) o la vaporesección (fibra frontal). En todos los casos se utilizó la fibra frontal (rigifib, flexifib y percufib), para vaporesección entre 12 y 15 Watts. Un total de 9 pacientes fueron tratados entre 2005 y 2008. Se realizó una nefrectomía parcial laparoscópica y 8 nefrectomías paciales mediante cirugía abierta por lumbotomía. Se realizó clampaje del pedículo en todas las nefrectomias parciales excepto en las 3 de estas últimas. Resultados: Todos los pacientes, 7 hombres y 2 mujeres, evolucionaron favorablemente, sin existir ninguna complicación relevante. Se trataba de 6 tumores en el lado izquierdo y 3 tumores en el lado derecho. El tamaño medio de los tumores fue de 3.5 cms, estando localizados 7 en el polo inferior y 2 en el polo superior. El tiempo medio de la cirugía fue de 135 minutos con la cirugia abierta convencional y 210 minutos con la nefrectomía parcial laparoscópica (NPL). El sangrado fue de 150cc en la NPL y 260 cc de media en los casos de cirugía abierta. Un caso se hizo mediante hipotermia renal de 50 minutos de duración. Conclusión: El láser Revolix® ofrece una excelente hemostasia y una precisa disección de la corteza renal. La carencia de burbujas y la mínima formación de gases favorece la utilización en la cirugía laparoscópica. Coagular vasos de hasta 1.6 mm permite un buen sellado de la superficie cruenta. Con la utilización de este tipo de láser se acortan los tiempos quirúrgicos, pues no hay necesidad de realizar suturas en el parénquima renal (AU)

Objective: Partial nephrectomy is a technique that requires extensive manipulation and control of the renal vessels. In this paper we will evaluate the contribution of Revolix® laser to the minimally invasive and nephron sparing renal surgery over the years 2005-2008. Methods: We have used the Revolix® laser (Thulium), with a wavelength of 2013 nm in the infrared (invisible) spectrum, which can work in a continue or pulsed manner. Its chromophore target is water. Two different techniques may be employed: vaporization (side firing fiber) or vaporresection (frontal fiber). In all cases we used the frontal fiber (rigifib, flexifib and percufib), for vaporresection between 12 and 15 watts. A total of nine patients underwent treatment between 2005 and 2008. We performed one laparoscopic partial nephrectomy and eight open partial nephrectomies through a lumbar incision. In all partial nephrectomies except three [open) the pedicle was clamped. Results: All patients, seven males and two females, had a favourable outcome, without relevant complications. The cases were six tumors in the left kidney and 3 in the right. Mean tumor size was 3.5 cm, being seven of them localized in the lower pole and two in the upper pole. Mean surgical time was 135 minutes with conventional open surgery and 210 minutes with laparoscopic partial nephrectomy. Estimated blood loss was 156 cc for laparoscopic partial nephrectomy and 260cc for open surgery. One case was performed under renal hypothermia with 50 minutes ischemia time. Conclusion: Revolix® laser offers an excellent haemostasis and precise dissection of the renal cortex. The absence of bubbles and the minimal formation of gases favour its use in laparoscopic surgery. 1t coagulates vessels of up to 1.6 mm allowing good sealing of the bloody surface. With the use of this type of laser surgical times are shorter, because there is no need to perform sutures of the renal parenchyma (AU)

[Treatment of benign prostatic hyperplasia with the Revolix laser]. / Tratamiento de la hipertrofia benigna de próstata con el láser Revolix.

OBJECTIVES: The treatment of benign prostatic hyperplasia (BPH) with the Revolix laser is effective. Its versatility enables 2 types of techniques: vaporresection and vaporization. Its chromophore target is water, like the holmium laser, with the difference that it may be used in both a continuous and pulsed mode. The continuous wave enables a precise cut and excellent hemostasis without diffusion to the neighbor tissues (0.2 mm penetration below the cut zone) with an excellent vision of the operative field. We report our experience after three years of treatment. METHODS: Revolix (thulium) laser has a wavelength of 2013 nm. 2 types of fibers, which reach a potency of up to 70 watts, are used to treat BPH. One frontal fiber for vaporresection and one fiber with side laser emission for vaporization. Both fibers may be combined to treat prostatic hypertrophy. Since the end of 2004 to March 2008 200 patients with BPH were treated. Prostate sizes varied from 20 to 120 g (mean 45 g). 99 patients underwent prostate vaporization, with sizes below 35 g, and 101 patients underwent vaporresection, with prostates over 35 g. Mean hospital time was 24 hours (range 1-4 hours). Mean catheterization time after laser treatment was 16 hours (range 12-72 hours). The efficacy of the treatment was evaluated with uroflowmetry, post void residual and evaluation of the symptoms with the IPSS questionnaire. RESULTS: The clinical results obtained after Revolix laser are comparable to those obtained after transurethral resection of the prostate, KTP laser vaporization or holmium laser enucleation. We demonstrate on important improvement of symptoms, with a decrease over 50% in the IPSS score, a significant improvement in the uroflowmetry, and a marked decrease of post void residual. No blood transfusions were required. There were only 4 patients that presented post operative acute urinary retention, requiring catheterization for a few days; all of them achieved spontaneous voiding posteriorly. No patient presented urinary incontinence after treatment with the Revolix laser. CONCLUSIONS: In our experience, the Revolix laser has demonstrated being safe, easy to install, with low operative cost, and a very short learning curve. Its efficacy may be better demonstrated using vapor resection for big prostates and vaporization for smaller prostates (the smaller than 35 g). The reduction of prostatic tissue is intermediate with a slight post operative discomfort and a low complication rate.

[What does Revolix laser contribute to partial nephrectomy?]. / Qué aporta el láser Revolix en las nefrectomías parciales?

OBJECTIVE: Partial nephrectomy is a technique that requires extensive manipulation and control of the renal vessels. In this paper we will evaluate the contribution of Revolix laser to the minimally invasive and nephron sparing renal surgery over the years 2005-2008. METHODS: We have used the Revolix laser (Thulium), with a wavelength of 2013 nm in the infrared (invisible) spectrum, which can work in a continue or pulsed manner. Its chromophore target is water. Two different techniques may be employed: vaporization (side firing fiber) or vaporresection (frontal fiber). In all cases we used the frontal fiber (rigifib, flexifib and percufib), for vaporresection between 12 and 15 watts. A total of nine patients underwent treatment between 2005 and 2008. We performed one laparoscopic partial nephrectomy and eight open partial nephrectomies through a lumbar incision. In all partial nephrectomies except three (open) the pedicle was clamped. RESULTS: All patients, seven males and two females, had a favourable outcome, without relevant complications. The cases were six tumors in the left kidney and 3 in the right. Mean tumor size was 3.5 cm, being seven of them localized in the lower pole and two in the upper pole. Mean surgical time was 135 minutes with conventional open surgery and 210 minutes with laparoscopic partial nephrectomy. Estimated blood loss was 156 cc for laparoscopic partial nephrectomy and 260 cc for open surgery. One case was performed under renal hypothermia with 50 minutes ischemia time. CONCLUSION: Revolix laser offers an excellent haemostasis and precise dissection of the renal cortex. The absence of bubbles and the minimal formation of gases favour its use in laparoscopic surgery. It coagulates vessels of up to 1.6 mm allowing good sealing of the bloody surface. With the use of this type of laser surgical times are shorter, because there is no need to perform sutures of the renal parenchyma.