PL 14. The Exploitation and application of the new laser technology in minimally invasive urologic surgery
Podium Lecture

PL 14. The Exploitation and application of the new laser technology in minimally invasive urologic surgery

Shu Jie Xia

Department of Urology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai 200080, China

Benign Prostatic Hyperplasia (BPH) has become the most common disease that endangers the health of the elderly men. With many possible preexisted conditions such as cardiovascular disease etc., the sugical risk of the aged would be much higher. Thus we established effective and safe laser technology in minimally invasive surgery. Despite of the benefit patients may gain from minimally invasive surgery when it comes to treating urolithiasis and urological tumours, severe complications which may result in nephrectomy or death have also raised awareness both at home and abroad. Through this study, we have solved these problems and get 11 patents. In this clinical reseach, we have not only established new non-invasive surgical techniques, but also creatively proposed several complication solutions and preventive measures.

We first introduce 2 μm thulium laser resection of prostatetangerine technique (TmLRP-TT) to treat BPH, which is a transurethral procedure that uses thulium laser fiber as the surgeon's fingers to resect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. With very little bleeding during surgery, the effectiveness and safety of the surgery has been remarkably increased. International academic circle gives high praise for this achievement. So far, we have already successfully performed in more than 1000 cases.

We first introduce thulium laser and holmium laser to radically excise bladder neoplasm at home and abroad. Followup visit indicated that compared with radical cystectomy, the short-term survival rate of this procedure is almost the same. With the bladder function preserved, the patients' postoperative quality of life is much more improved.

Percutaneous nephrolithotomy (PCNL) is usually performed with inflexible ureteroscope, which makes it difficult to capture the stones hidden in calyces. By applying flexible ureteroscope and flexible holmium laser fiber in treating complicated upper urinary tract calculi, we successfully solve this problem and get patent on flexible ureteroscope.

We are the first to perform nephron sparing surgery with 2um thulium laser. With few intraoperative blood loss, accurate incision and rarely reported complications, we believe it's a new approach to perform nephron sparing surgery.

Avulsion of ureteral mucosa is one of the severe complications of ureteroscopic laser lithotripsy and may result in nephrectomy or even death. Through this project, we discovered new method to reconstruct ureteral mucosa using free grafts obtained from peritoneum, impaired ureteral mucosa and bladder mucosa in order to avoid nephrectomy.

Septic shock and lethal massive haemorrhage are two severe complications that may result from PCNL. We proposed several complication solutions and preventive measures for PCNL.

Project members have published 112 articles, 37 of them are accepted by SCI journals, including European Urology (IF 7.643), the most distinguished and influential journal in urology. Theses are cited 239 times in all. And the number of scholars that attended our surgery demonstration at both domestic and international academic conferences is 9760 person-time. We host 2006 Asian Urological Association Annual Meeting Minimally Invasive Surgery Session and attend American Urological Association (AUA) Annual Meeting to lecture on our achievement. At the 3rd Greatwall International Andrology Forum (GIAF2008), the 26th World Congress on Endourology (WCE) and the 30th Congress of the Société internationale d'Urologie (SIU), we demonstrated the 2um thulium laser resection of prostate-tangerine technique (TmLRP-TT). And we were invited to Germany for academic exchange and lecture afterwards. Experts of the field speak highly of our work unanimously both at home and abroad. Now the 2um thulium laser resection of prostate-tangerine technique (TmLRP-TT) has been written in textbooks such as Minimally Invasive Urologic Surgery (published by Shandong Science and Technology Publishing House), Urological Surgery (published by People's Mecical Publishing House) and CSU Minimally Invasive Surgery Training Programme.

DOI: 10.3978/j.issn.2223-4683.2012.s229

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