PLASMA Vaporization Procedure Steps – Barnes Method
01｜Cystoscopy
Inspection of the Urethra and Bladder
02｜Marking of Resection Borders
After inspecting the left and right ostium, bladder, verumontanum and internal and external sphincter, start with the proximal marking of the verumontanum.
Use the coagulation mode (coag) of the loop/button electrode to superficially mark the resection borders at a distance of approximately two loops proximally to the verumontanum.
03｜Vaporization of the Medial Lobe, of Basal Portions of Lateral Lobes, and of the Floor of the Prostatic Cavity
Vaporization of the medial lobe and proximal part of the side lobes until the 5 o’clock and 7 o’clock positions.
Vaporization is done in layers instead of deep grooves.
If bleeding occurs, perform a spot coagulation without moving the button forwards or backwards (as known in monopolar surgery). To improve coagulation, use the edge of the button.
If it is necessary to cut, use the edge of the button in vaporization mode.
04｜Complete Vaporization of the Endovesical Part and the Endourethral Part of the Left Lobe Except for an Apical Remnant
Further ablate the endovesical part of the medial lobe and proceed with ablation of the endovesical and the endourethral part (except for an apical remnant) until the left lobe is completely vaporized.
The vaporization direction goes from dorsal to ventral and the other way round until the left lobe is completely vaporized.
Remove the tissue in layers in a vertical direction, starting on the floor of the cavity.
Be aware of bleeding and perform spot coagulation where needed. In most cases vessels are in the 11 and 1 o’clock positions.
05｜Complete Vaporization of the Endovesical and Endourethral Part of the Right Lobe Except for an Apical Remnant
Ablate the endovesical part and the endourethral part (except for an apical remnant) until the right lobe is completely vaporized.
The vaporization direction goes from dorsal to ventral and the other way round until the right lobe is completely vaporized.
Remove the tissue in layers in a vertical direction, starting on the floor of the cavity.
Be aware of bleeding and perform spot coagulation where needed. In most cases vessels are in the 11 and 1 o’clock positions.
06 | Final Vaporization of the Apical Part
To avoid postoperative voiding disturbances, the BPH should be removed completely. At the apex, remaining material can be vaporized or resected conventionally.
In contrast to the classical Barnes resection, all tissue material should be removed, including distal of the verumontanum.
Ensure hemostasis is obtained. Be aware of bleeding and perform spot coagulation where needed.
Place the electrode with slight pressure on the bleeding; activate coagulation mode and hold until the bleeding has stopped.
