SURGERY

EVIS EXERA IIPhotodynamic Diagnosis (PDD)

Recommended Instrument Set

MakingThe Invisible

Visible

Bladder cancer is the fourth common cancer in men and tenth in women, making total over 300.000 new cases in each year worldwide. Bladder cancer has the highest recurrence rate of any cancer and therefore patients require a lifelong follow-up. This is the reason bladder cancer is considered to be one of the most expensive cancer for the health-care system.

Cystoscopy and voided urine cytology are the gold-en standard in bladder cancer diagnosis and sur-veillance. Conventional white light cystoscopy has its limitation to detect flat carcinoma in situ (CIS) lesions. CIS lesions are often diffuse and multifocal and they are mimicking inflammatory changes in the urothelium. CIS, although a flat lesion, is an ag-gressive form of bladder carcinoma and can easily progress to an invasive tumour. Urinary cytology is usually positive in these cases, but does not help to localize these tumours.Photodynamic diagnosis (PDD) has been devel-oped to detect more precisely malignant bladder tumours, especially CIS lesions, dysplasia and small multifocal bladder tumours. In PDD the use of intravesical fluorescence photosensitising agent is combined with blue light endoscopy. Since the 1990s fluorescence agent has been 5-aminole-vulinic acid (5-ALA). The accumulation of porphyrin based photosensitising agent in malignant cells in-duces a visible red fluorescence with blue light illu-mination. Recently a more lipophilic ester of 5-ALA,

PDD for Detecting more Precisely malignant blaDDer tumours.

intro

hexyl aminolevulinate (HAL, Hexvix™) has been brought to the market. With HAL a short one hour instillation time is needed and the fluorescence is remarkable brighter compared to 5-ALA. The tech-nical development of endoscope systems makes the view of fluorescent lesions clear and precise which enables to perform even TUR with blue light illumination, if this is considered to be necessary. Many clinical trials have demonstrated PDD to detect distinctive more CIS lesions compared to standard white light cystoscopy. PDD is a practical tool with often significant implication in clinical de-cision making in bladder cancer patients. With the new photosensitising agent HAL and modern en-doscope equipment, PDD is probably still gaining wider acceptance worldwide in urological clinics.

Timo MarttilaMD, urologistAssistant medical directorDepartment of urologySeinäjoki Central Hospital

How PDD works

When a photosensitive marker* has been introduced transurethrally

into the bladder, the inner surface of the bladder absorbs the drug

over a period of 90–120 minutes and converts it into an endoge-

nous pigment called protoporphyrin IX. This pigment is then selec-

tively deposited in a tumor and, under blue excitation light, will emit

red fluorescence. Nevertheless, in this condition, good contrast of

the red fluorescence against the blue background cannot be ob-

tained because the red fluorescence is too weak as compared with

the blue light. To emphasize this fluorescence, a yellow filter exclu-

sively designed for PDD is built in into the scope. As a result, the

red fluorescence can be observed with good contrast.

*Two types are available: 5-aminolevulinic acid (5-ALA) and hexyl-

aminolevulinate (HAL).

tHe enDoscoPy towerOlympus peripheralequipment for advancedendoscopic procedures:

Components/Devices

Monitor – OEV191HFull digital HDTV high-resolution imageswith stable, flicker-free image quality

EVIS EXERA II Video System Center CV-180EXERA II is the first video platform introducing1080i HDTV to all fields of endoscopic imaging

Light Source – CLV-180The high-quality 300 W xenon lamp providesillumination ideal for endoscopy, allowing observation in deep sites or advanced techniqueswith standard and high intensity mode

HF Unit – UES-40 SurgmasterThe Olympus UES-40 SurgMaster – onegenerator for virtually any electrosurgical need

Compatible with PDD (Photo Dynamic Diagnosis)

EVIS EXERA IIPhotodynamic

Diagnosis (PDD)

instrument name std. opt.

N2277462 Video system center “CV-180” X

N2277252 Light source “CLV-180”,

(incl. N2504640 PDD filter

“MAJ-1429”) X

N2486200 Foot switch “MAJ-1391” X

N2487040 Camera head “OTV-S7ProH-FD” X

A4924 Video adapter “AR-TL08E” X

EVIS EXERA II provides a versatile platform that offers a basis of

advanced techniques in urology.

With a platform versatile enough to support all of today’s cutting-•

edge techniques in urology, EVIS EXERA II offers unprecedented

efficiency with capabilities that range from simple observation

to highly sophisticated visualization. High-definition imaging and

new image enhancement technologies enable you to confidently

perform complex, intricate procedures in urology.

EVIS EXERA II is equipped with a PDD function to enhance visu-•

alization of the bladder. When a special drug is administered to

the patient and the dedicated scope is used, the PDD function

produces heightened contrast between the fluorescent neoplas-

tic areas and the surrounding benign tissue for easy and effec-

tive visualization.

recommenDeD set for PDD

TURis Resectoscope

instrument name std. opt.

WA20016A Telescope, 4 mm, X 12° direction of view, autoclavable, with filter, for fluorescence diagnosis

WA20017A Telescope, 4 mm, X 30° direction of view, autoclavable, with filter, for fluorescence diagnosis

A93200A Light-guide cable, X for fluorescence diagnosis, plug type, 3 m, fluid, not autoclavable

WA22366A Working element, active X

WA22367A Working element, passive X

A22040A Inner sheath, X incl. standard obturator (A22081A)

A22026A Outer sheath, 26 Fr. X 2 stopcocks, rotatable

A22041A Resection sheath, 24 Fr. X incl. standard obturator (A22081A)

A22051A Irrigation port, X for resection sheaths, 1 stopcock, rotatable

A22071A Obturator, optical X

The OES Pro Resectoscope for TURis – Resection in Saline:•The TURis resectoscope is designed with convenience and comfort in mind. The placement of key connections makes it extremely well balanced, and the finger spread on the working element is reduced for less fatigue. In addition, the new high precision working element reduces friction force to a minimum and allows for an extremely smooth cutting experience. The logical locking system assures quick and secure assembly with one touch buttons for quick release.

TURis Resection Electrodes

instrument name std. opt.

HF-resection electrode, 12 pcs., sterile, single use,WA22301D loop, 12°, small X WA22302D loop, 12°, medium XWA22503D loop, 12°, large X

WA22305D loop, 30°, small XWA22306D loop, 30°, medium XWA22507D loop, 30°, large X

WA22521C band, medium, 12° XWA22523C band, medium, 30° X

HF-resection electrode, 12 pcs., sterile, single use,WA22331D angled loop, small XWA22332D angled loop, medium X

HF-resection electrode, 12 pcs.,WA22351C roller XWA22355C 45° needle X

WA22557C button, for plasma vaporisation X

WA22301D WA22302D

WA22305D WA22306D

WA22331D

WA22351C WA22355C

WA22321C

WA22557C

WA22332D

SurgMaster HF Unit

instrument name std. opt.

N1063440 HF unit “UES-40 SurgMaster”, X

220–240 V

Delivery includes:

HF unit, foot switch

MAJ-1258, and power cable

The Olympus UES-40 SurgMaster – one unit for virtually any

electrosurgical need. The Olympus SurgMaster covers almost

every application where electrosurgery is performed. One unit

enables the surgeon to perform Resection in Saline (TURis/TCRis),

conventional monopolar resection and to connect bipolar and

monopolar hand instruments as well.

SurgMaster – powered by Olympus.

One unit for all needs •

Transurethral Resection in Saline (TURis) and •

Transervical Resection in Saline (TCRis)

Monopolar and bipolar cutting and coagulation •

TURis Plasma Vaporization •

Excellent cutting and coagulation modes •

Automatic smoke evacuation•

Version 2.0

Rapid Plasma

Ignition

Accessories instrument name std. opt.

WA00013A HF cable, X

bipolar, 4 m,

for UES-40

A93200A Light-guide cable, plug type, X

for fluorescence diagnosis,

3.0 mm, fluid, not autoclavable

A0556 Syringe, X

150 ml, fixed cone

WA05970A Instrument tray, X

with lid

A5976 Insert tray, X

for resectoscope

Saline solution X

Lubricant (conductive) X

Silicone catheter X

O3657 Evacuator, X

acc. to Ellik

references- M. Babjuk, W. Osterlink, R. Sylvester, E. Kaasinen, A. Böhle. EAU Guidelines on Non-Muscle-Invasive Urothelial Carinoma of the Bladder. Juan Paluo - Redorta

- A. Stenzl, P. Jichlinski, D. Jocham, K. Junker, F. König, H. van der Bergh, B. Volkmer, D. Zaak, J.E. Geschwend. Consensrecommendation of the Working Group Oncology of the German Soceity of Urology (DGU) - P. Jichlinski. Hexyl aminolevulinate fluorescence cystoscopy: a new diagnostic tool for the photodiagnosis of superficial bladder cancer - a multicenter study. Journal of Urology 2003; 170: 226-9

- J. Schmidbauer, F. Witjes, N. Schmeller. Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy. Journal of Urology 2004; 171: 135-8

- A. Stenzl, H.B.G. Grossman. Hexvix® Fluoresecence Cystoscopy improves detection and resection of papillary bladder cancer and reduces early recurrence: A Multicentre, prospective, randomized study. European Urology Supplement 2009; 8(4):373

- B. Malavaud, C. Mazerolles. Photodynamic Diagnosis - Fluorescence assisted Cystoscopy in Non-Muscle-Invasive Bladder Cancer. European Urological Review 2009; 3(I): 41-43

system cHart PDD

Video System Center

MAJ-1391CLV-180

CV-180MAJ-1428

OEV191

PDD Camera Head

OTV-S7 ProH-FD

Adapter

AR-TL08E

PDD Light-Guide Cable

A93200A

4 mm PDD Telescopes

WA20016A, WA20017A,WA20018A

Flexible Cystoscope

N9019285

MAJ-1429PDD Filter

turis resection system

*Add A or T to the article number for the desired obturator: A220xxA standard obturator A220xxT obturator with deflecting tip

HF-Resection Electrodes

HF-Resection electrode,WA22301D loop, 12°, smallWA22302D loop, 12°, mediumWA22305D loop, 30°, smallWA22306D loop, 30°, mediumWA22331D angled loop, 12° and 30°, smallWA22332D angled loop, 12° and 30°, medium WA22351C roller, 12° and 30° WA22355C needle, 12° and 30°, 45° angled loop

WA22503D loop, 12°, largeWA22507D loop, 30°, largeWA22521C band, medium, 12°WA22523C band, medium, 30°WA22557C button, for plasma vaporizationWA22558C angled loop, 12° and 30°. for TUEB “Transurethral Enucleation”

For a detailed list of electrodes, see our Urology catalog.

Working Elements

WA22366A Working element, active

WA22367A Working element, passive

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WA22366A.eps

Rotatable Continuous Flow Resectoscope

Inner sheath,A22040* for 26 Fr. outer sheathA22041 for 27 Fr. outer sheath

Outer sheath,A22026A 26 Fr., 2 stopcocks, rotatableA22021A 27 Fr., 2 stopcocks, rotatable

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A22026A.ILL

Continuous Flow Resectoscope

Inner sheath,A22040* for 26 Fr. outer sheathA22041* for 27 Fr. outer sheath

Outer sheath,A22027A 26 Fr., 2 vertical stopcocks, fixedA22023A 27 Fr., 2 vertical stopcocks, fixedA22025A 27 Fr., 2 horizontal stopcocks

fixed

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A22027A.ILL

Standard Resectoscope

A22041* Resection sheath, without irrigation port, 24 Fr.

Irrigation port,A22051A 1 stopcock, rotatableA22052A 1 luer-lock connector, rotatableA22053A 2 horizontal stopcocks, rotatableA22054A 1 vertical stopcock, fixedA22055A 1 vertical luer-lock connector, fixed

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A22051A.ILL

Resectoscope with Intermittent Irrigation

A22014* Resection sheath, intermittent irrigation, 24 Fr.

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Telescopes

Telescope, 4 mm, autoclavable,A22001A 12° direction of viewA22002A 30° direction of view (for PDD use PDD telescopes WA20016A–18A)

WA03200A Light-guide cable, 3 mm, plug type (for PDD use A93200A)

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A22001A.ILL SurgMaster Electro-Surgical Unit

WA00013A HF cable, bipolar, for UES-40, 4 m length

UES-40 HF unit

new

W7.053. 672 1.5_10/09 Printed in Germany

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