D 678 GreenLight GB 08 - Richard Wolf

UrologyInstrument Set forGreenLightTM LaserLaser ResectoscopesLaser Cystoscopes

GreenLightTMLaser Vaporisation of the ProstateThe GreenLightTM laser is an important innovationin the surgical treatment of benign prostatichyperplasia. This treatment has becomeincreasingly established in Germany inrecent years. The special technical and physicalproperties of this laser allow treatmentof patients with multiple morbidity and thoseundergoing anticoagulative therapy.The high energy radiated by the GreenLightTMlaser vaporises the benign hyperplasticprostate tissue. A laser fibre of about thesame thickness as the refill for a ballpointpen is inserted through the urethra as far asthe prostate under direct vision. The highenergylaser light with a wavelength of 532nanometres (corresponding to the greenportion of the colour spectrum) is transmittedthrough the fibre to the prostate. Theenergy of this light beam is absorbed particularlystrongly by the red pigment in blood(haemoglobin).Wherever the laser beam is directed, theprostate tissue is vaporised in a fraction ofa second. The vaporised layer of tissue isonly one to two millimetres thick. The laserbeam cannot penetrate any further becauseit is practically completely absorbed by thered blood pigment (and the prostate is wellsupplied with blood) so that the entire energyis expended in the vaporisation. Thismeans that the tissue can be removed layerby layer under optical vision without bleedingor absorption of irrigation fluid. As aresult, the surgeon always has a clear viewof the operation that takes between 30 and90 minutes depending on the size of theprostate.One major challenge was to develop applicationinstruments for this new technologythat were suitable for the specific propertiesof this laser. A good view of the operatingsite is possible only with optimum irrigation.Previous cystoscopes provided poor guidancefor the fibre and caused disturbingvibration of the fibre which, in turn, shortenedthe working life of the fibre.Richard Wolf GmbH developed three applicationinstruments at the same time specificallyfor the GreenLightTM laser and ideal forthe individual operating technique of thesurgeon. A GreenLightTM laser cystoscopeand a GreenLightTM laser resectoscope aswell as a universal laser cystoscope weredeveloped specifically for the GreenLightTMfibre. Optimum irrigation conditions with50 % inlet and 50 % outlet and laser guidancewithout vibration were achieved ineach instrument allowing the retraction ofthe fibre into the sheath and preventing possibledestruction of the telescope andsheath. Handling of the laser resectoscopeis reminiscent of TURP and even allows theuse of a resectoscope working element.It is only possible to take advantageof this laser technologyand to optimise surgical resultsby using optimised applicationinstruments. Photoselectivevaporisation with the Green-LightTM laser is a new and promisingoperative technique forthe treatment of symptomaticbenign prostatic hyperplasia.Above all, Dr. Schiefelbein stresses theexcellent intraoperative safety even forpatients taking anticoagulants. This lasertechnique for direct ablationof tissue achieves functionalresults comparable withthe gold standard TURP. Thenew 120 watt HPS laser reducestreatment time and can improvethe efficiency of the therapy.CA Dr. Frank SchiefelbeinMissionsärztliches Klinikum Würzburg,Germany2

The GreenLightTM laser fibre is fixed in place directlywith the shifter in which the olive of thefibre is clipped into a special holder. This avoidsthe fibre being turned or displaced inadvertently.The shifter allows the fibre to be movedin the axial and radial direction while limitingtravel. This limitation is intended to prevent thefibre being advanced too far into the bladder ortoo far into the instrument so that the emittedlaser beam does not damage either the sheathor telescope.Laser cystoscopeWith the laser cystoscope specially designedfor the GreenLightTM laser, the lasercan be controlled in the axial and radialdirection in the instrument using the socalledshifter. The instrument also has aspecial laser guide that prevents vibrationand allows stable positioning of the laser.The fibre is therefore not subjected to mechanicalstress.With the options of combining the laserwith a continuous-irrigation cystoscopesheath or a continuous-irrigation resectoscopesheath, users can put together themodel they require.A patented laser guide specially designed forthe GreenLightTM laser fibre prevents vibrationand oscillation of the tip of the fibre in Green-LightTM laser cystoscopes and GreenLightTM laserresectoscopes. This has considerable advantagessince the user always views a steady image.This also ensures that the distance to thetissue remains constant. In turn, this alsoincreases the joule count of the laser.NewThe newly designed GreenLightTM"Freestyle" working insert guarantees completefreedom of movement allowing the user to manoeuvrein both an axial and radial directionwithout any restriction. The laser fibre is guidedfreely between thumb and index fingerproviding the laser fibre guidance that has pro-ved so successful with the special GreenLightTMinstrument set. It must, however, be pointedout that the totally free manipulation possiblewith this working insert means that incorrecthandling can lead to thermal damage to instruments.3

UrologyThe laser holder can be both rotatedand swivelled. This is especiallyuseful when working with angledlenses and protects the laser fibrefrom damage.Laser resectoscopeExperienced resectionists do not need tocompletely relearn because of the Green-LightTM laser. There is a laser resectoscopeworking element specially designed for theGreenLightTM laser fibre that fits either anextra thin 24.5 Fr. continuous-irrigationresectoscope sheath or the continuousirrigation22.5 Fr. laser cystoscope sheath.The working element can be rotatedthrough 360° in the continuous-irrigationresectoscope sheath and is therefore idealfor laser vaporisation. Movement in theaxial direction is achieved with a passive,spring-action working element. The fibre isturned by rotating the working element inthe resectoscope sheath.4

GreenLightTMInstrument SetThe fibre can be moved extremely preciselyand with a high degree of sensitivity. The intuitivehandling simplifies the work involved andin doing so also saves time. The laser fibre isfixed in position in the working element by theholder and the pressure button in the carriage.The fibre holder was designed so that the fibrecannot collide with the camera head whenusing a urological angled lens. A green seal onthe working channel allows the operator towork without water fountains.NewThe second working element "Freestyle" wasdesigned without a fibre shifter. This allows theuser totally free manipulation of the laser fibre.Ideally, these working inserts should be used ina straight resectoscope sheath otherwise there isa danger of thermal damage to the sheath andtelescope.For advanced GreenLightTM laser users, RichardWolf offers two different working inserts.One working insert was designed without anylimitation of the swivel angle but with a fibreshifter. Within this shifter, the fibre can be turnedthrough 360°.For all other laser fibres currently available onthe market or for customers who do not requirethe swivel limitation or the special guide, wealso offer a universal adapter for the continuous-irrigationcystoscope sheath. With this,fibres with a greater diameter can also beinserted or the GreenLightTM laser fibre can beused.Possible combinationsCystoscope sheath combined withlaser resectoscope working elementFor users who prefer a fenestrated sheath witha low Fr. calibre. This combination cannot,however, be rotated in the sheath.Laser cystoscope insert combined withresectoscope sheathCan be rotated through 360° and fitted withceramic tip. This provides the user with maximumfreedom of movement and ideal irrigation.Laser resectoscope with bipolar resectoscopeworking elementWithout changing sheaths, the user can vaporise,quickly resect "dry" and then insert thelaser fibre again to close the tissue. The sheathremains in the urethra in the meantime anddoes not need to be exchanged. This saves aconsiderable amount of time. Since the irrigationfluid does not need to be changed, themethod is extremely simple and quick and isparticularly suitable for large prostates.5

GreenLightTMTechnical Dataspirit of excellenceLaser cystoscope for GreenLightTM laserContinuous-irrigation outer sheath 22.5 Fr.for continuous-irrigation urethro-cystoscope,for "GreenLightTM laser" 22.5 Fr., E-line, withautom. snap-lockand irrigation tap ......................8632.026Continuous-irrigation inner sheathfor continuous-irrigationurethro-cystoscope........................8632.027Standard obturator........................8632.126Viewing obturator ........................8632.726Working insert with instrument guide channelfor safe guidance of the GreenLightTM laser fibre,no vibration, with limitation of the swivel angleof the laser holder for "GreenLightTMlaser instrument" ..........................8632.911Working insert * with instrument guide channel,for safe guidance of the GreenLightTM laserfibre, no vibration, without limitation of theswivel angle for "GreenLightTMlaser instrument" ..........................8632.912Working insert "Freestyle" with instrumentguide channel, for safe guidance of theGreenLightTM laser fibre, no vibration, withoutlimitation of the swivel angle for"GreenLightTM laser instrument" ........8632914also rubber cap long (orange)..........18.01Universal adapter for all laser fibrescurrently on the marketwithout fibre guide ....................8632.264Rubber cap (green)for sealing the laser guide channel(pack of 10) ..................................88.08PANOVIEW telescope 30°Ø 4 mm, without distortion ..........8654.422Laser resectoscope for GreenLightTM laserContinuous-irrigation outer sheath 24.5 Fr.for swivel continuous-irrigation resectoscope"E-line" 24.5 Fr., with profiled surface as lubricantreservoir, with autom.locking mechanism ......................8655.334Continuous-irrigation inner sheath 22.5 Fr.for continuous-irrigation double sheath systemwith automatic locking mechanism; straightsheath tip and distal ceramic insulation;working element can be rotatedthrough 360° in inner sheath ...... 8655.344Standard obturator..........................8654.16Viewing obturator ..........................8415.11Working elementwith closed handle, passive cutting action andinstrument guide channel, for safe guidance ofthe GreenLightTM laser fibre without vibration, for"GreenLightTM laser instrument"for 4 mm telescopesfrom 0° to 30° ............................8632.225Rubber cap (green)for sealing the laser guide channel(pack of 10)......................................88.08PANOVIEW telescope 30°Ø 4 mm, without distortion ........8654.422* Caution: If used incorrectly, the cystoscopesheath can be damaged!Combination: Laser resectoscope withbipolar resectoscope working elementContinuous-irrigation outer sheath 24.5 Fr.for swivel continuous-irrigation resectoscope"E-line" 24.5 Fr., with profiled surface as lubricantreservoir, with automaticlocking mechanism........................8655.334Continuous-irrigation inner sheath 22.5 Fr.for continuous-irrigation double-sheath systemwith automatic locking mechanism; straightsheath tip and distal ceramic insulation;working element can be rotatedthrough 360° in the inner sheath ....8655.344Standard obturator ..........................8654.16Viewing obturator ............................8415.11Working elementwith closed handle, passive, spring-assisted cuttingaction and instrument guide channel for safeguidance of the GreenLightTM laser fibre withoutvibration for "GreenLightTM laser instrument" for4 mm telescopes from 0° to 30° ....8632.225Rubber cap (green) for sealing the laserguide channel (pack of 10)..............88.08PANOVIEW telescope 30°Ø 4 mm, without distortion ............8654.422Bipolar working element with closed handle,passive cutting action for telescopes4 mm from 0° to 30° ....................8680.225Bipolar connecting cablesuitable for Erbe-VIO ......................8108.252Bipolar cutting electroderound for 30° telescope................4622.1333Bipolar coagulating electrodefor 30° telescope ........................4623.0243RICHARD WOLF GmbH · 75434 Knittlingen · PF 1164 · Telephone +49 70 43 35-0 · Telefax +49 70 43 35-300 · GERMANY · info@richard-wolf.com · www.richard-wolf.comPrinted on paper based on cellulose which has been bleached without the use of chlorine.Specifications subject to change without notice.D 678.VII.08.GB.2 www.stuetzlepartner.deAUSTRIA · BELGIUM / NETHERLANDS · FRANCE · GERMANY · INDIA · U.A.E. · UK · USA