Boston Scientific AMS 700 Mode D'emploi page 15

Figure 29. Flush tubing
22. Attach a 15 gauge blunt tip needle to a 60 mL syringe and fill it with 55 mL of sterile
normal saline. Prepare another 60 mL syringe in this manner.
23. Attach the 60 mL syringes to the cylinders.
24. Inflate the cylinders to evaluate erection quality.
Note: Check for placement of the cylinder tip, any cylinder buckling, kinking, or
disruption of the suture line, or fluid leakage from the cylinder.
25. Deflate to evaluate flaccidity.
26. For each cylinder, reclamp the cylinder tubing (one notch only) 2.5 cm from the needle
top using a blue shod mosquito hemostat. Remove the 15-gauge needle and syringe.
Implant the Reservoir
Infrapubic Implantation
1. Create a defect in the rectus fascia and a pocket in the prevesical space under the
rectus muscle and insert the reservoir.
Note: The reservoir tubing may be routed through the rectus fascia using the Tubing
Passer. When using Tubing Passers, the tubing should be placed on the knobbed
end of the passer and passed through the fascia. As an alternative, route the tubing
directly through the midline between the rectus muscles.
Penoscrotal Implantation
1. Create a defect in the transversalis fascia through the external inguinal ring (Figure
30). This defect provides access to the prevesical space. You may find access
to the inguinal ring and prevesical space easier using the baby Deaver retractor
provided in the SKW Retractor Kit. The Deaver is placed in the inguinal ring and
pulled toward the head, revealing the inguinal ring. Once the pocket is created in
the prevesical space, use your finger to place the reservoir into the space.
Figure 30. Create defect
Note: Alternatively, the prepared reservoir may be placed in the prevesical space
through a small inguinal incision. Make a defect in the prevesical space under the
rectus muscle large enough to accommodate the reservoir without putting pressure on
it. Then insert the reservoir.
Fill the Reservoir
Use two 60 mL syringes with 1 mL gradations when filling the 65 mL or 100 mL reservoir.
1. Remove the blue shod mosquito hemostat from the reservoir tubing.
2. Flush the reservoir tubing with sterile normal saline using a 22-gauge blunt tip
needle on a 10 mL syringe.
3. Using the 60 mL syringe and a 15-gauge blunt tip needle, fill the reservoir with the
appropriate amount of sterile normal saline. Generally, the amount of fluid should be
equivalent to the size of the reservoir (65 mL or 100 mL). However, the 100 mL Conceal
Low Profile Reservoir can be filled up to 100 mL to accommodate all cylinder sizes.
4. Using a blue shod mosquito hemostat, re-clamp (one notch only) the reservoir tubing
2.5 cm from the tip of the needle. Remove the 15-gauge needle and syringe.
Note: Do not allow excess tubing to lie on the reservoir
Close the Corporotomies
1. Close the tunicae albuginea with either a running horizontal mattress stitch or
preplaced sutures, with meticulous attention to hemostasis.
Note: If using a mattress stitch, you may place the winged end of the Reusable Closing
Tool or the foot of the disposable Proximal Tool over the cylinder to protect it while
suturing. Move the tool along the incisions with each stitch to protect the cylinder.
Implant the Pump
1. Use blunt dissection to form a pocket in the most dependent portion of the scrotum
(Figures 31 and 32). The pump may also be placed in a dependent position between
the two testicles.
Figure 31. Infrapubic: Bluntly dissect
2. Insert the pump into the scrotal pocket.
3. Apply Allis or Babcock clamps to the pump tubing through the scrotal skin to hold
the pump in place during the remainder of the procedure.
4. A suture may be placed to secure the pump in the scrotum, if desired.
5. Ensure that the length of the tubing between the cylinders and the pump fits the
patient's anatomy.
• If using a nonconnected system, make the connections between the cylinders
and pump.
• The length of the tubing between the AMS 700™ preconnected cylinders and
pump can be adjusted using the AMS 700 Accessory Kit.
Refer to the instructions on making connections in the Connect the Tubing section.
Note: Extra tubing between the pump and cylinders of the AMS 700 CX, CXR, and LGX
Preconnect may be tucked within the surrounding tissues.
Complete the Surrogate Reservoir Test
Before connecting the tubing between the pump and reservoir, perform a surrogate
reservoir test to ensure that the pump and cylinders work well together.
CAUTION: To avoid damaging the pump, don't inject fluid into the black color coded
reservoir line of the pump using a syringe.
1. Submerge the black color coded reservoir tubing of the pump into a basin with at
least 55 mL of sterile normal saline.
2. Remove the blue shod mosquito hemostat from the tubing and squeeze the pump
inflation bulb to inflate the cylinders, making the penis erect.
3. Confirm that the cosmetic result is satisfactory. Cylinders should be rigid without
bending or buckling.
4. Deflate the cylinders by squeezing the pump's deflate button for 4 seconds.
5. Remove all of the fluid from the cylinders, by gently squeezing the penis/cylinders to
return the fluid to the basin. Evaluate flaccidity.
6. With the tubing still in the saline, reclamp the reservoir tubing with a blue shod
mosquito hemostat.
Connect the Cylinders and Reservoir
After successfully completing the surrogate reservoir test, connect the pump and the
reservoir. Refer to the instructions on making connections in the Connect the Tubing section.
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Figure 32. Penoscrotal: Bluntly dissect
Black (K) ∆E ≤5.0