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REVOLIX™ 2 MICRON – THE REVOLUTION CONTINUES

Advanced Laser Technology from LISA Laser USA

In the mid 1970’s laser technology was introduced for surgical applications. Since then , many new applications and procedures have been identified for this technology. LISA Laser USA (Pleasanton, CA) has been a leader in this revolution, presenting cutting edge technology with wide range of novel applications of the RevoLix™ 2 micron laser. This device is a major advance over other laser systems, providing efficient vaporization, better hemostasis, in a very cost effective way. It offers a wide variety of applications in urology, and most of the procedures can be safely performed in hospital, surgery center or office. The various applications are summarized in the diagram, and include lithotripsy as an additional procedure for which the RevoLix DUO™ can be used.

The Challenge and The Solution

The challenge met by LISA laser was to combine the best features of previously existing technologies, which resulted in their continuous wave laser with a wavelength of λ=2013 and target chromophore of water. It is a full contact laser and employs a forward firing fiber for precise delivery of the laser energy. Unlike the pulsed energy of the Holmium laser, the RevoLix delivers a continuous flow of energy allowing tissue to be easily vaporized while providing excellent hemostasis.

Cost Effective

Cost is an important consideration. Other BPH lasers use single use fibers that cost around $1000 and occasionally use multiple fibers for one patient. The RevoLix 2 micron laser employs reusable fibers which offers considerable savings and brings the costs down to lower than $200 per procedure. The RevoLix can also be used for vaporesection. This procedure provides not only tissue for histology but also a higher professional reimbursement.

These benefits are further extended by the flexible financial arrangements offered by LISA Laser USA who make units available for purchase, lease or rental.

Practical Experience

To date over 10,000 BPH procedures have been performed in the United States with excellent clinical outcomes. There are many applications in urology for the RevoLix™ and most can be performed in the physician’s office.

Brian Parker, MD, Urology Consultants of Tennessee, Knoxville, TN has used the RevoLix™ and confirms the many advantages to this technology. He prefers the end-firing capability and the precision afforded for the resection of tissue. “This wavelength generates little to no necrotic tissue. Because there is very little necrotic tissue, you can see the target area much more clearly. There is no guessing as to the volume of tissue removed and the capsule is easily identified.” He goes on to say, “The patient outcomes are superior with the RevoLix™ and I feel that if more physicians knew about the technology, they would use it.”

Michael L. McClelland, MD Chief of Urology at Seton Medical Center, University of Texas, Austin, has had positive experiences with the technology. “After doing a large number of cases with both the RevoLix™ and the Green Light Laser, I firmly believe the RevoLix™ laser is superior. I can vaporize tissue more efficiently and more completely with the RevoLix™.” He also speaks about the post-operative experience of his patients. “They appear to have fewer irritative symptoms with the RevoLix™ and are happier with the results sooner. Both lasers obviously work for obstructive BPH, but after using both, I believe the RevoLix™ is a superior way to treat my patients.”

Another experience comes from Frederick A. Klein, MD, FACS, Professor of Surgery and Chief of the Division of Urology at the University of Tennessee, Knoxville, TN. He comments that “the RevoLix 2-micron laser is a wonderful technology.” He also speaks to the clear sight that the technology affords. “Basically, the RevoLix™ allows us to do bloodless prostate ablation. It is fast with perfectly clear vision. The advantages of the RevoLix™ are that you do not have to wear goggles, it is easily done with a camera, and there is no bubbling or white fluffy tissue that is seen with Holmium.”

He also addresses the flexibility of the technology. He concludes “the bottom line is the RevoLix™ 2-micron is effective and operator friendly. I would suggest it as the laser of choice for a prostate ablation. ” He also sees benefits for the patient. “With the RevoLix™ they are treated as an outpatient and they usually take out their catheter the next day and are satisfied with this.”

Conclusion

The development of the RevoLix™ 2 micron laser offers the surgeon a safe, superior and very affordable technology with significant advantages over other lasers. Procedures can be performed safely in the office saving the physician and patient both time and money. This is made even more attractive by the flexibility offered by Lisa Laser to sell, lease or rent units. This exciting breakthrough technology deserves a much wider audience!

To learn more about the RevoLix™ family of lasers, Please call 1-888-573-5006 or visit our web site www.lisalaserusa.com.

Abstract

Multiple laser systems for the treatment of
benign prostatic hyperplasia (BPH) have been introduced.
Current laser systems have limitations due to their laser
physics. The Revolix TM laser combines the advantages of
the Holmium:YAG laser with the comfort of a continuous
wave (cw) laser beam. This study reports the preliminary
results of vaporesection (simultaneous vaporization and
resection) of the prostate, using the 2 pm cw laser. A total
of 54 consecutive patients were treated with the 70 Watt Revolix
laser for BPH. The mean age was 61 years. Mean
prostate volume was 30.3 cc. A 550 pm Rigi Fib bare ended
fiber was used in combination with a 26 French laser
resectoscope. Measured outcomes were resection time,
decrease in hemoglobin and transfusion rate. Furthermore,
the catheter time, improvement in the urinary flow rate
(Qmax), post-voiding residual urine (PVR), International
Prostate Symptom Score (IPSS) and Quality of Life Index
(QoL) were recorded. Average resection time was 52 min.
After crossing the learning curve, a tissue ablation of I.5 grams/
min was possible. Transfusions were not necessary in any patient. Catheter time was 1.7 days. QMax significantly
improved from 4.2 to 20.1 ml on average. PVR decreased
from 86 to 12 ml,IPSS and Qol-Score improved from 19.8
to 6.9 and 4 to 1, respectively. No patient required re-hospitalization.
These preliminary results indicate that RevoLix vaporesection of the prostate is safe and efficient.
One-year follow-up data showed a significant improvement
in voiding symptoms and patients’ quality of life. A longer
follow-up is needed to prove the durability of these promising results.

The Holmium laser was for a long time the Gold Standard for Prostate Resection but recently the vaporization of the prostate using the KTP laser has become more popular.
The hemostatic effect of the 2.1 micron wavelength was the prevailing advantage for application of the Holmium laser for the enucleation of the prostate. However the pulsed emission mode of the Holmium laser only favored the enucleation protocol which requires additional morcellation of the enucleated tissue. Vaporization and clean resection of prostatic tissue with this laser is made more difficult and requires a long learning curve.
The hemostatic effect of the RevoLix laser allows the successful treatment of patient who are on an anticoagulant medication.
The KTP laser wavelength has been used for a long time in the treatment of vascularized tissue, as for example in the treatment of the epidermis. This wavelength is heavily absorbed by hemoglobin and causes an immediate hemostatic effect. In less vascularized tissue the absorption of this wavelength is reduced and the unintentional interaction with deeper tissue becomes more likely.
However the continuous wave 2 micron RevoLix laser appears to solve many of the limitations of both these devices. This wavelength is heavily absorbed by any tissue independent of the degree of vascularization. The strong absorption of this wavelength by any irrigation fluid allows the use of front firing fibers without any risk to effect the opposite bladder wall. Front firing fibers allow varying between vaporization and resection of tissue only depending on the degree of pressure of the fiber tip to the tissue.
Both techniques combined offer the ability to vaporize or vaporesect or resect the prostate which is a big advantage allowing surgeons to approach TURP like speeds without any of the complications. This treatment bandwidth of the RevoLix laser allows this laser to be used even for larger glands where vaporization takes too much time and the resection effect becomes an advantage.
Patients that have already had a TURP procedure very often develop low vascularized bladder neck sclerosis. In this case a retreatment with the KTP laser is more difficult because of the lack of hemoglobin in the sclerotic tissue to absorb the KTP laser radiation. Contrary the RevoLix laser finds its target molecule independent of the degree of vascularization and therefore is the preferred laser.

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