Boston Scientific AMS 700 Mode D'emploi page 14

Insert the Cylinders
A traction suture has been placed through the distal tip of each cylinder. Depending on
surgeon preference, either before or after inserting the cylinder into the crus, complete
the following steps:
1. Use the Furlow Insertion Tool (Figure 24) and Keith Needle to help introduce the
cylinders into the corpora cavernosa.
Figure 24. Furlow Insertion Tool
2. To help prevent cross over through the intercarvernous septum when placing the
first cylinder, a dilator or other surgical tool may be placed in the contralateral
corpus cavernosum.
3. Check the function of the Furlow Insertion Tool by withdrawing the obturator to the
locking groove, for the "retracted" position, and then fully insert the obturator until
the tip appears at the end.
Note: Keith Needles are included in the AMS 700™ Accessory Kit.
4. Withdraw the obturator to the "retracted" or "locked" position. Pass both ends of
the cylinder traction suture (approximately 10 cm) through the eye of a Keith Needle
(Figure 25).
Figure 25. Insert traction suture into Keith Needle
5. Load the blunt end of this needle into the Furlow Insertion Tool (Figure 26) and place
the suture into the tool slot.
Figure 26. Load Keith Needle
6. Completely retract the suture into the slot and fully draw the needle into the barrel
of the tool.
7. Hold the four strands of suture against the tool and insert the tool into the distal
portion of the corporal body until the front tip is at mid glans.
Note: It is imperative that patient's penis is aligned symmetrically with his body and
that the location of the glans puncture is satisfactorily identified before pushing the
needle through the glans. The Furlow Insertion Tool should be in the ipsilateral corpora
at the distal tip.
Note: If you cross over through the intercavernous septum to the contralateral side,
remove, place the dilator into the contralateral side and reposition the Furlow Insertion
Tool on the ipsilateral side. No repair is necessary.
Black (K) ∆E ≤5.0
8. Place the penis on a mild stretch; push the needle through the glans by fully
inserting the obturator into the barrel.
9. Grasp the needle with a needle holder or mosquito hemostat, and pull it completely
through the glans.
10. Detach the needle from the suture, and remove the needle from the area to prevent
any accidental cylinder punctures.
11. Attach a tubing-covered hemostat to the traction suture to prevent inadvertent
retraction through the glans.
12. Insert the front tip of the cylinder into the corporotomy.
13. Gently push the cylinder distally into place from the corporotomy.
Note: Use the traction suture to guide the cylinder until the front tip is placed at mid
glans. Take care not to twist the cylinder as it is being placed.
14. Carefully assess the front tip position of the cylinder at mid glans to verify proper
cylinder placement.
Note: Take care to leave the traction suture in place through the glans to allow the
cylinder to be repositioned. If repositioning or more dilation is required, the cylinder
should simply be pulled out of the corporal body.
15. Before placing the proximal end of the cylinder, slightly retract the distal tip of the
cylinder several centimeters in the proximal direction.
16. Fold the cylinder back on itself, and then push the proximal end of the cylinder into
the crus while gently stretching the distal penis (Figures 27 and 28). Alternatively,
place the "U" shaped portion of the proximal tool at the junction between the output
tube and cylinder and use the tool to push the proximal end of the cylinder into the
crus while gently stretching the distal penis. The flatter side of the tool should face
toward the cylinder.
Figure 27. Infrapuic: Insert cylinders
17. Once the proximal portion of the cylinder is in place, reposition the distal portion at
mid glans by gently pulling on the traction suture.
18. Assess the cylinder length for satisfactory fit within the corpora cavernosa by
ensuring that the distal tip is snugly at mid glans, the cylinder lies within the
corporotomy, and the proximal end is firmly against the crus. If not satisfactory,
remove the cylinder, adjust the length as needed, and re-implant.
19. Repeat the procedure to insert the remaining cylinder into the other corporal body.
Perform the Inflate/Deflate Test for Nonconnected Cylinders
An optional inflate/deflate test to ensure nonconnected cylinder integrity after placement
may be performed. The test may be conducted before or after the corporotomies are
closed. If performed before closure, place the thumb and another finger over the
corporotomy sites before inflation.
20. Remove the blue shod mosquito hemostats from the cylinder tubing.
21. Flush the cylinder tubing with sterile normal saline using a 22-gauge blunt tip needle
on a 10 mL syringe (Figure 29).
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Figure 28. Pensocrotal: Insert cylinders