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

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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

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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