홀륨수술 Holmium Laser Ennucleaation of Prostate (HoLEP)

 

Holmium Laser Ennucleaation of Prostate (HoLEP)

Indication : 전립선 비대증 benign prostatic hyperplasia

 

✿ setting

n/s 2개 + TUR Line = tissue enucleation 연결

n/s 2개 + TUR Line = morcellator 연결

 

 

 

 

 

 

1. Set 및 부속

drape	◽Cystoscopy	◽발자루
신형	◽원익 morcellator instrument + scope ◽신형 suction 투명 suction line
구형	◽4mm 30도 scope ◽light cable ◽mocellator tip + handpiece ◽nephroscope
prn	◽laser 550 stripper ◽TUR 변경시 : Elick&spoid ◽sound 11ea

 

 

2. 준비 물품

준비 물품

◽30cc sry(2) / 10cc sry(1) ◽enema sry(1) ◽TUR-Line (natural drain) 2개 ◽sani-sleeve ◽3-way

◽suction line ◽laser fiber 550 ◽urine bag ◽22Fr 3way foley

 

 

 

 

 

 

 

 

 

 

 

 

 

 <신형 nephroscope>

-nephroscope 

-은색 connector

-4mm 30도 scope

-endoscope forcep

-obtulator

-26fr sheath 2ea

-elick connector

-working element + 고무마개

추가) 투명 suction line 챙기기

 

 

 

working element는 홈에 들어가게 끼운다.

 

 

고무마개는 홈에 쏙 들어가게 끼운다

​

<구형 nephroscope>

​동시에 여러 case인 경우에는 prostate의 무게에 따라 구형/신형 나눠서 사용

 

 

① Outer , inner sheath, obtulator 조립

② Laser resectoscope sheath (고무마개) + 4mm 30도 scope조립

③ 1,2을 합체ㅏ여 550 laser (energy1.8/rate30) 이용하여 prostate tissu를 enucleation

 

 

nephroscope을 사용 할 때 기존의 4mm 30도 scope에서 변경되므로 따로 sani-sleeve를 씌여놓는다.

 

 

 

3-Way 하나 더 준비하여 TUR-Line 연결

 

⑤Post op care : 22fr 3-way foley 넣어 continuous bladder irrgation 한다.

 

<수가 주의사항>

① 홀륨레이저를 이용한 전립선 광 적출술

② 유치카테터

 

 

 

 

 

 

 

 

 

 

 

Holmium laser enucleation of the prostate (HoLEP) is the endourologic procedure for BPH treatment that most closely approximates open simple prostatectomy.   The cutting characteristics of the holmium laser are used to develop a plane between the prostatic adenoma and the surgical capsule of the prostate. The enucleated tissue is removed through a process of morcellation. 

Randomized controlled clinical trials have shown advantages of HoLEP to be reduced catheterization times, length of hospitalization, and blood loss. The hemostatic nature of the holmium laser has also allowed HoLEP to be performed on patients taking antithrombotic therapy. Although HoLEP can be used effectively to treat prostates of any size, it is particularly advantageous for the treatment of large prostate, providing a minimally invasive alternative to open simple prostatectomy. 

Randomized controlled trials have demonstrated outcomes of HoLEP to be equivalent to that of transurethral resection of the prostate (TURP) and simple open prostatectomy. Bladder stones, a common pathology found with BPH, can be treated with the same holmium laser fiber used to perform laser enucleation

 

Hinman's Atlas of Urologic Surgery

Fourth Edition

Copyright © 2018 by Elsevier, Inc. All rights reserved