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Disquectomiá Endoscópica LASE

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LASE Endoscopic Disectomy: Welcome to the LASE physicians training video after watching this tape you should have a good understanding of the LASE procedure. View the package insert for complete set of instructions. LASE Endoscopy Disectomy permits physicians to offer a definitive treatment to patients suffering from a several symptoms due to a contain herniated or ball on lumbar disc this patients may otherwise, undergo open surgery or be managed with temporizing treatment treatment LASE offers the advantages of minimum invasive therapy, including local anesthesia, limits length of stay and minimal push procedure pain must patience at this discharge several hours after the procedure many experience significant pain relief during the procedure or shortly after in the majority of patients who respond do so within one week. The long term saccesorate is approximately 85% . compete open surgery on contained discs, LASE offers a higher successorate and reduce the damages of the posterior spinal elements that now jeopardizes the opportunity for subsequent spinal surgery. LASE Endoscopy Disectomy is a procedure for treating contain lumbar discs is not indicated for free fragments, extrusions or for patience with significant boney compressure. Kit and procedure: In this video we will introduce the LASE kit components and show you how to set up forth and complete a LASE procedure. First let’s identify all the items in the lace kit: This is the LASE endoscope, the LASE endoscope is actively deflectable and it contains a built in laser fiber it has four connections image, illumination, irrigation, and laser. The image connection provides a video picture. The illumination connection provides light to the endoscope. The irrigation line provides saling solution for cooling The laser fiber is connected to a wholly aimed laser. Two LACE kit models are available: One is a Cohere brand laser fiber connector. and the other one has a trimmer dime implant laser fiber connector. Using this now you can position the laser fiber from one to six millimeters from the endoscope distant lent. Let’s take a brief look on connecting the LASE kit to the endoscopy tower. You can connect LASE to almost any endoscopy tower, if you use this adaptors, they are close like cable, and a clearance endoscope coupler, choosing which model off each to use is beyond off the scope of this tape but it isn't complicated. Attach the image connector to the endoscopy tower's light cable this way The image connector is simple too, align the pins on the LASE image connector, push, twist close wise, and its armed turn to test that its securely attached. If you wish rotate the image connector to orient the image Here’s how you focus the image, this technique requires only one person and two hands. Place the distant lent of the end of the endoscope on the external drive, grasp the endoscope coupler a little bit distantly with one hand and hold the focusing wing with the other hand, turn until the image is small, then look at the perimeter of the image and make this edge as sharp as possible if its sharp you’ll find that the image is perfectly focused. The LASE endoscope is placed into the disc, trough a working channel identify the working channel by its green dot, a triangular skin stop helps secure the working channel against the patient skin, the working channel has an aspiration port for removing the salient urgent you could lose it or tighten the working channel grip at the end of the endoscope shaft by turning a compression fitting. Straight and curved working channels are available, the curved working channel is sometimes required by the 5 F 1 disc the dilator fits inside the working channel and makes the working channel tip less traumatic. You will use the lace kit trephine by a cut through the annulus, identify the trephine by its red dot. the LASE kit contains a flexible guide needle, this is the first kit component to enter the patient’s body you will pass the dilating working channel pale over the guide needle . The LASE kit contains four additional items: the scalple a roller, a stilet, and a pen. the stilet is packaged inside the trephine, you can use it as a sterile point or a push disc fragment blocking the working channel out of the way, now that we had introduced the components of the kit, let's see how they are used clinically. LASE Endoscope Disectomy can be performed in patients who are positioned in either or lateral decubitus or prone possition. this patient is prone, prepare and drape the patient. hold the lace kit stile in one hand use fluid to find an entry point, and anaesthetize the entry point and the track using a syringe on the other hand. To introduce the kit's guide needle into the disc, put the siam in an oblique view as for discography remove the needle's protector cap and advance the needle to the center of the nucleus nucleus you may need to use your other hand to keep the needles proximal and bent out of the way of the siam head verify your position with the Ep and allow a fluoroscopy there are many to go through you have to decide the way on the patient to enter some physicians enter the lateral side others choose the contra lateral side and so others choose either the left or the right side based on the layout of the procedure all strategies seem to be equally successful. Next you should use the kit scalpel to make a stab wound by the guide needle so the working channel and the dilator could pass through the skin and facie easily . lock the working channel and the dilator together and pass them over the guide needle advance them to the annulus , check with Ap an later would fluid, you go to splay to the distant working channel into the nucleus here's how: Remove the dilator from the working channel, insert the trephine, screw the annulus trough the trephine, then remove the trephine, reinsert the dilator , lock it on to the working generals hub. advance both the working channel and the dilator into the nucleus place a full by full between the skin and the skin stop and tighten the skin stop remove the dilator, attached the aspiration tube in and you are ready to insert the lace endoscope. Connecting irrigation is also easy, one in goes into the lace endoscope irrigation line and the other one goes to a one lead of bag of normal sealing put the irrigation line into the endoscopy pump and close to pump it, prime the pump, then set the pump to deliver 30cc of saline per minute, proper irrigation and aspiration are crucial to keep into the endoscopes tip and the disc cool, this picture shows the path of the saline, if the working channel becomes blocked the aspiration cooling will be compromised if the Laser fiber is buried in tissue, the tip can easily overheat cooling with proper irrigation and aspiration is crucial for the safety of the case. Connect the Laser fiber to a Laser this way: Position the endoscope and slide trough the working cannel sliding in trough the endoscope you’ll see the working channel walls then the disc, the laser fiber is at a 9:00 o clock position, rotate the image connector to reposition to the 3:00 o clock position position if you want up in the endoscope to correspond to up on the television merge turn on the red aiming beam, it makes the Laser fiber much more visible set the Laser energy many physicians start at 1,4 J/pulse @ 10 HZ ten pulses per second or 14 W later in the case after you establish the cavity you might increase the pulse energy to 2.0 j/pulse @ 15 HZ impulses per second or 30 W. You need to chose an energy that works safely for the individual patient. Fire the laser, gently advance in the endoscope rotate the endoscope to enlarge the opening keep the tip of the Laser fiber in view for much of the case you will simply be advancing and retracting the laser fiber rotating it to each different quadrants while you move back and forth rotating you might be concerned that the cavity does not seem to be enlarging you get this perception because as you vaporize the nucleus papooses from the disc center more nuclear material herniated itself into the cavity this process will continue for most of the case. when you are vaporizing most of the surpass nucleus the cavity would finally begin to enlarge and you can begin to deflect the endoscope part of the endoscope tip is reserved for later in the case. Whenever deflecting, be sure not to pull de endoscope back as the working channels distal age can shelf off his tip even a small cut on the endoscope shaft can cause a leak seriously compromising the fluid of irritant and cooling into the endoscope tip your goal with the Laser is to create a cavity shaped like a piece of pie the e packs of the cavity is the distal end of the working channel the cavity should be widest in the axe you are playing and narrowest on the southern quadrant direction the claurus laser only travels short distance on water that's why this Laser is so good for disquectomy almost all the light is absorbed completely within two millimeters while this short range as a Laser safety it does as presented a difficulty the laser fiber tip need to be in contact or near contact to the disc for a toar blade if you are fighting seems happening consider advancing the Laser fiber. There are two ways to do this. One just moves the endoscope forward. Two, you can turn the laser fiber advance by realize the scoop handle clockwise using this now you can position the Laser fiber from 1mm to 6mm 6mm from the endoscope distant lamp, remember that the distant lamp of the endoscope is radium pink sothe laser fiber can extend up to additional 6mm don’t bury the Laser fiber in tissue, that can lead to overheating to determine the endpoint of the procedure consider both a total energy delivered and the appearance of the disc cavity, most of physicians deliver 15 Kj of energy but there are no rules that can be applied on all patients. ask the Laser operator to a put delivered energy every KJ he appearance of the disc cavity can also be a useful guide to identify the end point early on the case the cavity would collapse as you go towards the the end begins to stay open some physicians turn off the laser and the irrigation and watch the cavity as the patient coves if the cavity closes up you should probably start lasing again don’t forget to turn on the pump proper irrigation and aspiration are crucial withdrawing for the last time time you see the working shadow walls and outside the body you see the jade of irrigant. Withdraw the working channel. Some doctors inject an antibiotic into the disc and the track trough the working channel, as they withdraw the working channel close the wound use an oversize dressing will help remind the patient that no matter how good they feel, they just undergone a disquectomy. reframing the lace case is not difficult you use the guide needle working channel, dilator and Trephine to position the lace endoscope into the nucleus under constant endoscopic control you used the built LASE fiber to vaporize the nucleus papooses constant irrigation and aspiration helped to keep the disc cool you can determine the location of the endoscope tip at anytime using fluid learning how to do LASE helps you to provide a definitive minimum invasive therapy to your patients your patients would appreciate your efforts. Learn more about LASE at our website or by attending a LASE presentation.

Video Details

Duration: 16 minutes and 20 seconds
Country: Mexico
Language: English
License: All rights reserved
Producer: LASE
Director: James Beretta,D.O. Craig Lambie, Steven Rodde, Vijay Singh, M.D.
Views: 80
Posted by: monicahb on May 13, 2013

Procedimiento quirúrgico para tratar lesiones lumbares.
Surgical procedure to treat hernieted lumbar discs.

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