ATOMS Surgical Instruction Manual_2013.indd
Contents
1. ATOMS System ATOMS Implant Puncture protection 5 Mesh arm 6 Fixation suture 7 Catheter coupling piece 8 Port needle Preparation e Lithotomy position patient under spinal Or general anaesthesia e Sterile preparation Draping plug anus with gauze ana tape with adhesive strips e Tape sterile bag Dissection of bulbar urethra Prepare an area on both sides of the bulbospongiosus muscle with Out cutting the muscle itself The obturator foramen is easily palpable e Roux retractor amp wound retractor e A M I Tunnellers e Universal linen set e 2 gowns side drape leggings e Adhesive strips e Place catheter wrap sterile compress around glans penis to absorb any urethral secretion e Attach urine bag let it hang down over the stomach patient s right Implant positioning Correct positioning of the ATOMS implant The catheter must lie on the patient s left hand side and point upwards Page 1 4 e Compresses e Suction bag e 2x blade size 20 e Syringes 1 x 20 ml for rinsing the wound 1 x 10 ml NaCl 0 9 for filling the implant e Urine bag e Silicone catheter CH 14 e Anaesthetic antiseptic lubricant e Polypropylene absorbable braided absorbable monofila ment non absorbable for securing the implant and port subcutiular and perineal wound closure Implantation Start by making a perineal incision approximately 6 cm long Mesh arms placemen2. t To get a feel for the correct inser tion of the A M I TOA Tunneller practise outside the body near the inferior pubic ramus by guiding the tunneller around in the air A M I A M I ATOMS System Mesh arms placement Use the outside in approach The suture loop of the mesh arm on the patient s left is hooked onto the tip of the left tunneller and the tunneller then penetrates the obturator foramen Mesh arms placement Repeat on the patient s right hand side Mesh arms placement The tip of the left tunneller should exit in the distal perineal wound Using the forefinger push the bul bar urethra to the patient s right hand side at the point where the tunneller is expected to exit Then rotate the tunneller carefully until it can be felt by the forefinger Mesh arms placement Pull the right hand mesh arm through and tighten it Page 2 4 Mesh arms placement Pull the left hand mesh arm all the way through Remove the protective sleeves pull first on one arm and then on the other to bring them as close as possible to the bone and ensure the implant is securely in place Mesh arms fixation Ensure the sutures are grouped together correctly Mesh arms fixation Hold the mesh arms tight and determine where the fixation sutures should be passed through the mesh arms to achieve firm positioning of the implant Mesh arms fixation Cut off the remainder of the mesh arm appro
3. the port incision needle delivered with the ATOMS in multiple layers with a subcuticu set Puncture the port membrane lar suture inject all the fluid and then remove it again to empty the system of air Subsequently fill again with 4 6 ml of saline Closure of wound Closure of wound Adjustment of system Close the perineal wound in three The procedure is complete Make the first adjustment to the layers system after the 4th postoperative week A M I
4. x 1 cm above the fixati on sutures A M I I ATOMS System Page 3 4 ka Mesh arms fixation Irrigation of implant site Port implantation Tie each suture pair to the Rinse the wound with a betadine Create a port bed in the left sym Corresponding sling arm solution physeal region just above the base of the penis Port implantation Port implantation Port implantation Make an incision approx 3 cm Use the slightly curved A M I TVA Connect the catheter coupling long ana Create a deep Tunneller to tunnel subcutaneously piece to the catheter and hook it subcutaneous port pocket towards the left perineal wound on to the tunneller s tip Port implantation Port implantation Port implantation Pull the catheter up to the port Place the puncture protection over Cut the catheter down to the site incision Avoid any contact the catheter correct length taking care to with skin avoid kinks A M I A M I ATOMS System Page 4 4 Port implantation Port implantation Port implantation Connect the port to the catheter Screw the puncture protection Place the port into the port bed Once avoiding any contact with the onto the port and secure it in place with sutures skin Port implantation Filling of system Closure of wound Rinse the wound with a betadine Use a 10 ml syringe filled with iso Rinse the wound with betadine solution tonic saline and the special port solution and close
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