Hakan POLAT, Volkan TUĞCU, Doğukan SÖKMEN, Ali İhsan TAŞÇI

Transüretral prostat cerrahisinde kullanılan farklı enerji kaynaklarının doku penetrasyon derinliklerinin karşılaştırılması

Amaç: BPH tedavisinde kullanılan monopolar TURP, bipolar TURP ve 120 W Lithium triborate LBO laser uygulamalarının çevre dokularda oluşturduğu penetrasyon derinliklerini insan prostat dokusu üzerinde belirlemek ve birbirleri ile karşılaştırmak. Gereç ve Yöntemler: Transüretral prostatektomi planlanan 39 hasta non-randomize olarak üç gruba ayrıldı. İlk iki grupta monopolar grup-1 ve bipolar grup-2 elektrokoter kullanılarak prostat rezeksiyonu, 1 saniye ve 2 saniye koagülasyonlar yapıldı. Alınan doku materyalleri histopatolojik olarak değerlendirildi. Grup3’te LBO laser ile prostat vaporizasyon ve koagülasyonları uygulandıktan sonra TUR ile doku örneklemesi yapılarak alınan örnekler histopatolojik olarak değerlendirildi. Oluşan koagülasyon zonları belirlenerek karşılaştırıldı Bulgular: Gruplara göre ortalama koagülasyon derinliği grup 1’de 221,33±9,33, grup 2’de 248,33±17,18, grup 3’de 2103,33±101 μm olarak belirlenmiştir. Her bir grubun koagulasyon zonu karşılaştırıldı ve 120 W Lityum triborat LBO lazer grubun koagülasyon zonu derinliği monopolar ve bipolar TURP grubundan daha derin bulundu p 0.05 . Sonuç: 120 W Lityum triborat lazer LBO tarafından çevre dokularda oluşturulan termal hasar monopolar ve bipolar TURP’ye göre daha derin katmanlara ulaşmaktadır. Bu etki, daha iyi kanama kontrolü, daha iyi bir görüntü ve daha az kan kaybına neden olabilir

Anahtar Kelimeler:

bipolar koter, BPH, Lithium triborate laser, monopolar koter, transüretral prostat cerrahisi

Comparison of tissue penetration depths of different energy sources used in transurethral prostatic surgery

Objective: To evaluate and compare tissue penetration depths of monopolar TURP, bipolar TURP and 120 W Lithium triborate LBO laser in human prostatic tissue. Materials and Methods: 39 patients scheduled for transurethral prostatectomy were divided to 3 groups, nonrandomly. In monopolar group group-1 and bipolar group group-2 prostate was resected by electrocautery and coagulation was applied for 1sec and 2sec. Resected tissue samples were examined histopathologically. In group-3, following prostate vaporisation and coagulation by 120 W Lithium triborate LBO laser, TUR were performed for tissue sampling and histopathologic examination. Composed coagulation zones were detected and compared. Results: Resection groups, mean values than the other groups, 1 second and 2 seconds after the process of coagulation coagulation zones were compared in all groups formed by the LBO laser coagulation, monopolar and bipolar TURP zone depths were found to be statistically significantly higher. The difference between monopolar and bipolar TURP groups was not statitistically significant p>0.05 . Conclusion: Termal injury in the surrounding tissue generated by 120 W Lithium triborate LBO laser reached to deeper layers compared with termal injury of monopolar and bipolar TURP. This effect may obtain better homeostasis, visualization and lesser blood loss nevertheless periprostatic structures may be negatively affected. These effects should be evaluated with better histologic identifications and there is need for advanced studies evaluating erectile functions objectively.

Keywords:

bipolar cautery, BPH, 120 W Lithium triborate LBO laser, monopolar cautery, transurethral prostatic surgery,

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