AUS placement: The 30-minute technique

Section Editor’s note:‘Y’tube, a video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. Here, three high-volume implanters demonstrate how precise setup and preparation can facilitate a rapid, minimally invasive, and successful artificial urinary sphincter (AUS) placement. Dr. Peterson demonstrates a unique method for cuff sizing, while Dr. Broghammer demonstrates another technique to optimize this crucial step of the procedure. Dr. Elliott displays a remarkable 30-minute AUS placement that is facilitated through a number of time-saving maneuvers. All surgeons demonstrate the importance of sharp dissection and clear exposure of the urethra.

This video presents a streamlined, 30-minute approach to AUS insertion.
 

Dr. Hotaling: Dr. Elliott illustrates a rapid and efficient approach to AUS implantation that reduces operative time to less than 30 minutes. Keeping the legs level with the ground prior to bringing them up into lithotomy facilitates maximal working room and ergonomics for a surgeon and assistant to work. Sharp dissection is used to facilitate exposure, and clear visualization allows circumferential dissection of the urethra. Excellent use of the scrub tech to prepare the device while the surgeon is working decreases operative time.

The use of a subinguinal incision, commonly employed for varicocelectomy, allows easy placement of the balloon without a larger, more painful incision and also facilitates placement of the pump without the need for excessive dissection. The ability to remove the retractor only once and not have to replace it further reduces operative time. Parallel connections further reduce operative time.

Ultimately, Dr. Elliott demonstrates a very safe, rapid, and efficient approach to AUS placement that is done through very small incisions.

More AUS videos:

AUS placement: Key steps in the Duke technique

AUS placement: Updated perineal approach
 

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