HOLEP 3 Lobe Technique
Conference Name: ProSurg 2016
Surgeon(s)/Speaker(s): Dr. Prashant Mulawkar
Surgical Procedure: Urology-HOLEP- Three lobe
Location: Tirthankar Superspeciality Hospital Akola
Indexsteps
1. Diagnostic cystoscopy : Diagnostic cystoscopy, assess the size of prostate, locate the ureteric orifice. Evaluate the bladder.
2. Passage of resectoscope : Passage of resectoscope as per the size of urethra, either blind or visual
3. Resection on the floor just proximal to veru : Resection on the floor just proximal to veru
4. Incision on both the sides of median lobe : Incision on both the sides of median lobe
5. Enucleation of the median lobe : Enucleation of the median lobe
6. Enucleation of right lateral lobe : Enucleation of right lateral lobe
7. Enucleation of left lateral lobe : Enucleation of left lateral lobe
8. Morsellation of the specimen : Morsellation of the specimen
9. View from veru : View from veru to assess the completeness of the procedure
10. Examining both ureteric orifices : Examining both ureteric orifices
11. Catheterization : Catheterization
pre_post_measures
1. Preoperative investigations : lab parameters: routine: : hb, cbc, sr creat, urine r/m, bld grp, pt, ptt, platelet, hiv, hbsag :new: blood sugar random (fasting and postprandial, if diabetic) :new:if partient has ckd: then urea, creatinine, na, k :new: coagulation profile :new: usg abdomen and pelvis :new: psa if necessary :new: phycician opinion and other inv as directed by physician like: chest x-ray, ecg, echocardiogram :new: abdominal ultrasound examination
2. Preoperative measures : hospitalized one day prior in night :new:attachment of the diathermy plate :new:padding of the pressure points :new:lithotomy position :new:dose of prophylactic antibiotic at the time of induction of anaesthesia :new:anti-embolic stockings / placement of an intermittent compression device on the legs if necessary
3. Postoperative measures : monitoring of temperature, pulse and blood pressure :new:allow the patient liquids and diet after 3-4 hours :new:intravenous fluids for the first 6 - 12 hours :new:catheter removal on day 2,3 or 4 depending on bleeding and whether the patient has passed motion or not
4. Warning signs in the postoperative period : patient feels unwell anytime :new:hematuria :new:tachycardia :new:hypotension :new:fever
Surgical Instruments
1. I-Drive
2. Tristaple Reloads
3. Ligasure Maryland - 44cm
4. ValleyLab FT10 Energy Platform