SURGERY

EVIS EXERA II
Photodynamic Diagnosis (PDD)

Recommended Instrument Set

Making
The Invisible
Visible

Intro
Bladder cancer is the fourth common cancer in
men and tenth in women, making total over 300.000
new cases in each year worldwide. Bladder cancer
has the highest recurrence rate of any cancer and
therefore patients require a lifelong follow-up. This
is the reason bladder cancer is considered to be
one of the most expensive cancer for the healthcare system.

PDD for detecting more precisely

malignant bladder tumours.
Cystoscopy and voided urine cytology are the golden standard in bladder cancer diagnosis and surveillance. Conventional white light cystoscopy has
its limitation to detect flat carcinoma in situ (CIS)
lesions. CIS lesions are often diffuse and multifocal
and they are mimicking inflammatory changes in
the urothelium. CIS, although a flat lesion, is an aggressive form of bladder carcinoma and can easily
progress to an invasive tumour. Urinary cytology is
usually positive in these cases, but does not help to
localize these tumours.
Photodynamic diagnosis (PDD) has been developed to detect more precisely malignant bladder
tumours, especially CIS lesions, dysplasia and
small multifocal bladder tumours. In PDD the use
of intravesical fluorescence photosensitising agent
is combined with blue light endoscopy. Since the
1990s fluorescence agent has been 5-aminolevulinic acid (5-ALA). The accumulation of porphyrin
based photosensitising agent in malignant cells induces a visible red fluorescence with blue light illumination. Recently a more lipophilic ester of 5-ALA,

hexyl aminolevulinate (HAL, Hexvix) has been

brought to the market. With HAL a short one hour
instillation time is needed and the fluorescence is
remarkable brighter compared to 5-ALA. The technical development of endoscope systems makes
the view of fluorescent lesions clear and precise
which enables to perform even TUR with blue light
illumination, if this is considered to be necessary.
Many clinical trials have demonstrated PDD to
detect distinctive more CIS lesions compared to
standard white light cystoscopy. PDD is a practical
tool with often significant implication in clinical decision making in bladder cancer patients. With the
new photosensitising agent HAL and modern endoscope equipment, PDD is probably still gaining
wider acceptance worldwide in urological clinics.

Timo Marttila
MD, urologist
Assistant medical director
Department of urology
Seinjoki Central Hospital

How PDD Works

When a photosensitive marker* has been introduced transurethrally
into the bladder, the inner surface of the bladder absorbs the drug
over a period of 90120 minutes and converts it into an endogenous pigment called protoporphyrin IX. This pigment is then selectively deposited in a tumor and, under blue excitation light, will emit
red fluorescence. Nevertheless, in this condition, good contrast of
the red fluorescence against the blue background cannot be obtained because the red fluorescence is too weak as compared with
the blue light. To emphasize this fluorescence, a yellow filter exclusively designed for PDD is built in into the scope. As a result, the
red fluorescence can be observed with good contrast.

*Two types are available: 5-aminolevulinic acid (5-ALA) and hexylaminolevulinate (HAL).

 THE endoscopy TOWER

Components/
Devices

Olympus peripheral
equipment for advanced
endoscopic procedures:

Monitor OEV191H
Full digital HDTV high-resolution images
with stable, flicker-free image quality

EVIS EXERA II Video System Center CV-180

EXERA II is the first video platform introducing
1080i HDTV to all fields of endoscopic imaging
Light Source CLV-180
The high-quality 300 W xenon lamp provides
illumination ideal for endoscopy, allowing
observation in deep sites or advanced techniques
with standard and high intensity mode

HF Unit UES-40 Surgmaster

The Olympus UES-40 SurgMaster one
generator for virtually any electrosurgical need

Compatible with PDD

(Photo Dynamic Diagnosis)

Recommended Set for PDD

EVIS EXERA II
Photodynamic
Diagnosis (PDD)

Instrument name

std. opt.

N2277462

Video system center CV-180

N2277252

Light source CLV-180,

(incl. N2504640 PDD filter
MAJ-1429)

N2486200

Foot switch MAJ-1391

N2487040

Camera head OTV-S7ProH-FD

A4924

Video adapter AR-TL08E

EVIS EXERA II provides a versatile platform that offers a basis of

advanced techniques in urology.
With a platform versatile enough to support all of todays cuttingedge techniques in urology, EVIS EXERA II offers unprecedented
efficiency with capabilities that range from simple observation
to highly sophisticated visualization. High-definition imaging and
new image enhancement technologies enable you to confidently
perform complex, intricate procedures in urology.
EVIS EXERA II is equipped with a PDD function to enhance visualization of the bladder. When a special drug is administered to
the patient and the dedicated scope is used, the PDD function
produces heightened contrast between the fluorescent neoplastic areas and the surrounding benign tissue for easy and effective visualization.

TURis
Resectoscope

Instrument name

std. opt.

WA20016A

Telescope, 4 mm,
12 direction of view,
autoclavable, with filter,
for fluorescence diagnosis

WA20017A

Telescope, 4 mm,
30 direction of view,
autoclavable, with filter,
for fluorescence diagnosis

A93200A

Light-guide cable,
for fluorescence diagnosis,
plug type, 3 m, fluid,
not autoclavable

WA22366A

Working element, active

WA22367A

Working element, passive

A22040A

Inner sheath,
incl. standard obturator (A22081A)

A22026A

Outer sheath, 26 Fr.

2 stopcocks, rotatable

A22041A

Resection sheath, 24 Fr.

incl. standard obturator (A22081A)

A22051A

Irrigation port,
for resection sheaths,
1 stopcock, rotatable

A22071A

Obturator, optical

The OES Pro Resectoscope for TURis Resection in Saline:

The TURis resectoscope is designed with convenience and
comfort in mind. The placement of key connections makes it
extremely well balanced, and the finger spread on the working
element is reduced for less fatigue. In addition, the new high
precision working element reduces friction force to a minimum
and allows for an extremely smooth cutting experience. The
logical locking system assures quick and secure assembly
with one touch buttons for quick release.

TURis Resection
Electrodes

WA22301D

WA22305D

WA22302D

WA22306D

Instrument name

std. opt.

WA22301D
WA22302D
WA22503D

HF-resection electrode,
12 pcs., sterile, single use,
loop, 12, small
loop, 12, medium
X
loop, 12, large

WA22305D
WA22306D
WA22507D

loop, 30, small

loop, 30, medium
loop, 30, large

X
X
X

WA22521C
WA22523C

band, medium, 12
band, medium, 30

X
X

WA22331D
WA22332D

HF-resection electrode,
12 pcs., sterile, single use,
angled loop, small
angled loop, medium

X
X

WA22351C
WA22355C

HF-resection electrode,
12 pcs.,
roller
45 needle

WA22557C

button, for plasma vaporisation

WA22321C

WA22331D

WA22351C

WA22332D

X
X

WA22355C

WA22557C

SurgMaster
HF Unit

2.0 a
sioPnlasm
r
e
V id on
RapIgniti

Instrument name

N1063440

HF unit UES-40 SurgMaster,

220240 V

Delivery includes:
HF unit, foot switch
MAJ-1258, and power cable

std. opt.
X

The Olympus UES-40 SurgMaster one unit for virtually any

electrosurgical need. The Olympus SurgMaster covers almost
every application where electrosurgery is performed. One unit
enables the surgeon to perform Resection in Saline (TURis/TCRis),
conventional monopolar resection and to connect bipolar and
monopolar hand instruments as well.
SurgMaster powered by Olympus.
One unit for all needs
Transurethral Resection in Saline (TURis) and
Transervical Resection in Saline (TCRis)
Monopolar and bipolar cutting and coagulation
TURis Plasma Vaporization
Excellent cutting and coagulation modes
Automatic smoke evacuation

Accessories

Instrument name

std. opt.

WA00013A

HF cable,
bipolar, 4 m,
for UES-40

A93200A

Light-guide cable, plug type,

for fluorescence diagnosis,
3.0 mm, fluid, not autoclavable

A0556

Syringe,
150 ml, fixed cone

WA05970A

Instrument tray,
with lid

A5976

Insert tray,
for resectoscope

Saline solution

Lubricant (conductive)

Silicone catheter

O3657

Evacuator,
acc. to Ellik

REFERENCES
- M. Babjuk, W. Osterlink, R. Sylvester, E. Kaasinen, A. Bhle.
EAU Guidelines on Non-Muscle-Invasive Urothelial Carinoma of the Bladder. Juan Paluo - Redorta
-



-

A. Stenzl, P. Jichlinski, D. Jocham, K. Junker, F. Knig, H. van der Bergh, B. Volkmer, D. Zaak,
J.E. Geschwend. Consensrecommendation of the Working Group Oncology of the German Soceity of
Urology (DGU)
P. Jichlinski. Hexyl aminolevulinate fluorescence cystoscopy: a new diagnostic tool
for the photodiagnosis of superficial bladder cancer - a multicenter study.
Journal of Urology 2003; 170: 226-9

- J. Schmidbauer, F. Witjes, N. Schmeller. Improved detection of urothelial carcinoma in situ with

hexaminolevulinate fluorescence cystoscopy. Journal of Urology 2004; 171: 135-8
- A. Stenzl, H.B.G. Grossman. Hexvix Fluoresecence Cystoscopy improves detection and resection
of papillary bladder cancer and reduces early recurrence: A Multicentre, prospective,
randomized study. European Urology Supplement 2009; 8(4):373
- B. Malavaud, C. Mazerolles. Photodynamic Diagnosis - Fluorescence assisted Cystoscopy
in Non-Muscle-Invasive Bladder Cancer. European Urological Review 2009; 3(I): 41-43

System Chart PDD

4 mm PDD Telescopes

Adapter

WA20016A, WA20017A,
WA20018A

Flexible Cystoscope
AR-TL08E

N9019285

PDD Light-Guide Cable

PDD Camera Head

A93200A

OTV-S7 ProH-FD

Video System Center

CV-180
MAJ-1428

OEV191

MAJ-1429
PDD Filter
CLV-180

MAJ-1391

TURis Resection System

Rotatable Continuous Flow Resectoscope

Telescopes

Inner sheath,
A22040* for 26 Fr. outer sheath
A22041 for 27 Fr. outer sheath

A22001A
A22002A

Outer sheath,
A22026A 26 Fr., 2 stopcocks, rotatable
A22021A 27 Fr., 2 stopcocks, rotatable

Telescope,
4 mm, autoclavable,
12 direction of view
30 direction of view
(for PDD use PDD telescopes WA20016A18A)

WA03200A Light-guide cable,

3 mm, plug type
(for PDD use A93200A)

Working Elements
WA22366A Working element,
active

Continuous Flow Resectoscope

Inner sheath,
A22040* for 26 Fr. outer sheath
A22041* for 27 Fr. outer sheath

Outer sheath,
A22027A 26 Fr., 2 vertical stopcocks, fixed
A22023A 27 Fr., 2 vertical stopcocks, fixed
A22025A 27 Fr., 2 horizontal stopcocks
Artikel-NR.
Mastab: fixed

Datum
nderung:

Datum
Erstellung:

von:
Mastab:
Artikel-Bezeichnung:
Standard Resectoscope
Datum
nderung:
A22041*
ILL-Name:Resection sheath,
von:

von:
Artikel-NR.

without irrigation port,von:

Irrigation port,

ILL-Name:
A22051A 1 stopcock, rotatable

Datum
nderung:
Mastab:
von:

Artikel-Bezeichnung:

13.12.01
Lubert

Datum
Erstellung:

WA00013A

13.12.01
von:
Lubert

WA22301D
WA22302D
WA22305D
WA22306D
WA22331D
WA22332D
WA22351C
WA22355C

Datum

new

ILL-Name:

Datum
Datum
*Add A or T to the article number Erstellung:
for the desired obturator:
26.9.01
nderung:

von:

A220xxA
A220xxT

Artikel-Bezeichnung:
ILL-Name:

WA22521C
WA22523C
WA22557C


WA22558C

Artikel-NR.
Datum
Erstellung:

von:
Artikel-NR.

Datum
Erstellung:

loop, 12, large

loop, 30, large
band, medium, 12
band, medium, 30
button,
for plasma
vaporization
angled loop,
12 and 30.
for TUEB Transurethral Enucleation

15.3.0
Lube

15.3.0

WA22366A.eps
von:
Sperlic

Artikel-Bezeichnung:
A22027A.ILL

Artikel-NR.

Mastab:

HF cable, bipolar,
for UES-40,
4 m length

HF-Resection electrode,
loop, 12, small
loop, 12, medium
loop, 30, small
loop, 30, medium
angled loop, 12 and 30, small
angled loop, 12 and 30, medium
roller, 12 and 30
needle, 12 and 30, 45 angled loop

Mastab:
Artikel-Bezeichnung:

von:

A22001

HF-Resection Electrodes

von:
von:
Lubert
nderung:
ILL-Name: with Intermittent Irrigation A22040A.ILL
Resectoscope
WA22503D
Artikel-Bezeichnung:
ILL-Name:WA22507D
A22014*
Resection sheath,

intermittent irrigation,

ILL-Name: 24 Fr.

26
L

UES-40 HF unit

Datum
nderung:

21.9.01

von:

SurgMaster Electro-Surgical Unit

A22026A.ILL
Mastab:

Datum
Erstellung:
Artikel-NR.
von:

Datum
Erstellung:

ILL-Name:

21.9.01
A22040A.ILL
Lubert

luer-lock connector, rotatable

horizontal stopcocks, rotatable
Artikel-NR.
vertical stopcock, fixed
vertical luer-lock connector, fixed

Artikel-Bezeichnung:
Datum
nderung:

von:

Datum
Erstellung:

24 Fr.
Artikel-Bezeichnung:

A22052A 1
A22053A 2
Mastab:
A22054A 1
A22055A 1

Artikel-NR.

Mastab:
WA22367A Datum
Working element,
nderung:
passive

standard obturator
von:
obturator
with deflecting tip

Lubert

Mastab:
A22041A.ILL

For a detailed list of electrodes,

see our Urology catalog.

Artikel-NR.

WA22367A_fly.ep

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