PSS UROLOGY INC.
The Urology Company
PSS Urology was created with one simple goal: to address the needs of Urologists with the highest quality products at the best price delivered with excellent service. The disappearance of specialty companies through consolidation into conglomerates has left a gap in service and focus and has raised prices beyond what is reasonable. PSS seeks to reestablish service with integrity, reasonable pricing and top quality products with complete satisfaction guaranteed. We hope that you will give us a chance to show you our commitment to the specialty of Urology.
Industry History of Bipolar Resection and Vaporization
Bipolar Resection or Vaporization in a saline-medium (isotonic solution) is known by many names: TURis, Saline Resection, TUVis, Button Resection, Plasma Vaporization, or simply Bipolar Resection in Saline. The procedure has been widely used for over a decade.
First Applications were in Gynecology
The first equipment for the procedure was developed by Gyrus Medical in the mid 1990’s. The original unit was the grey PlasmaKinetic (PK) bipolar electrosurgical generator, designed as a bipolar vessel-sealing platform for use in Gynecology. After some experimentation, Gyrus added a “cut” algorithm allowing for cutting as well as coagulation in endoscopic gynecology. This led to the further development of bi-polar cutting and vaporization electrodes. With the first generator (the PK Platform) the “coag” function was unsatisfactory for Urological applications.
Challenges Transferring Technology to Urology
Efforts to adapt technology to Urology faced many obstacles.
1. The waveforms (both cut and coag) were not properly modulated to provide appropriate power levels for urology.
2. Existing scope technology combined with suboptimal waveforms, impacted firing of the electrodes.
3. TURP Technique with Saline is different from monopolar technique.
a. Saline does not lyse red-blood cells and allows for “Coagulation in real-time” rather than performing multiple cuts followed by coagulating when the visual field filled with blood.
b. Saline-based resection eliminated the risk of TUR Syndrome, although the risk of fluid overload remains even with an isotonic solution (NACL 0.9%).
c. Urologists slowed cutting to allow coagulation of small vessels while cutting. Bipolar electrodes form a “Plasma-Pocket”, also known as a “Plasma-Corona” around the surface of the electrode. Bipolar loops “cut” through tissue by vaporizing tissue. This vaporizing cut coagulates tissue adjacent to the cut.
d. Electrodes configured like the “wedge” (Gyrus Medical/ACMI), or the more recent “Button” Device or “PlasmaButton” (Olympus Medical/OlympusACMI) or finally PSS Urology’s HEMI-Vaporization Electrode, (#HititwiththeHEMI) the plasma-pocket or plasma-corona forms around the surface area of the electrode and delivered into the tissue as a plasma-bubble to achieve tissue removal via bipolar vaporization of the underlying tissue. Urologists slowed their cutting/vaporization gestures to minimizing the intraoperative bleeding. The net result is that Saline-TURP procedures reduce intraoperative blood loss.
i. Some Urologists deploy an “eraser” technique whereby they localize the energy intensely in one area in very quick back-and-forth motions, minimizing exposure to the underlying layers of tissue to excess heat.
e. Another variable examined during this time was the intraoperative temperature of saline. Temperature was believed to impact ignition and maintenance of the Plasma-Pocket or “Plasma Corona” surrounding the electrode.
i. It was established that maintaining saline at body temperature enhanced electrode firing. The Thermedx Fluid-Manager made by Allen-Medical performs this function. This device also reduces bubble formation during the procedure, improving visualization and reducing procedure time.
4. Second generation devices such as the PK-SP, Olympus’ UES-40 or the Karl Storz “Autocon” use improved waveform algorithms than earlier generators. Gyrus produced the PK-SP “Gyrus SuperPulse” generator (REF744000) which was widely adopted from 2004-2010. This device has seen many software updates and is in wide use today. The main reason for its success is the use of an alternating 50/50 duty cycle that delivers power for several minutes without interruption. This feature served to reduce procedure times.
Third-Generation technologies come from three manufacturers; ERBE’s Vio 300D, ValleyLab’s Force Triad/FT-10 and Olympus’ ESG-400, which is an amalgam of the Gyrus SuperPulse (PK/SP, REF744000) and the Olympus UES-40. These products replace the stated value-setting with wattage, which is more straightforward.
This evolution of technologies allows for greater speed and precision in both Urological and Gynecological applications. The ability to provide modulated waveforms allows Urologists to fine-tune energy delivery to accommodate different tissue compositions.
Much is known about the many variables that impact the ideal combination of device configuration, energy algorithms and generator designs to allow system optimization for all the situations a urologist may encounter. We at PSS have been involved in this aspect of urology since the beginning. We are dedicated to enhancing, simplifying and perfecting the products we make to maximize efficiency and reduce costs in every way we can.