Laser bidirectional atraumatic and radiopaque tip catheter with direct visualization via endoscope

Q1. Who is the right candidate for the SELD?

SELD may be done on a patient with a bulging disc or ruptured disc.

When the disc is too hard, it can’t be treated by the laser.

Therefore, you are requested to check the disc freshness by MRI or CT in advance.

The Sacrum’s length should be more than 2.5mm at least to introduce the catheter.

If a patent’s sacrum is less than 2.5mm, SELD is hard to be done because Veeler catheter can’t be introduced

Q2. What is the best position to introduce the catheter?

A patient position will determine the success of SELD. You should try to keep the flat back position as much as you can which makes easy to introduce the catheter to the targeted point.

Q3. How to measure the optimized lengths of laser fiber, endoscopic cable and catheter tip?

It is the best to measure & mark the optimized lengths of the laser fiber, endoscopic cable and catheter tip prior to the operation.

The endoscopic cable may be inserted though the catheter and be out 1cm more than the catheter.

You may mark the point on the endoscopic cable with the steri-strip.

You may measure the length of the bulging disc and mark the length on the laser fiber by the protruded disc length. It may help you not introduce the laser fiber more than the requirement.

Q4. How to introduce the catheter?

“Ventral Approach” is the most desirable theoretically.

However, this approach may be not allowable depending on the bulging disc location or the patient condition which might has an adhesion in the pathway to the targeted point.

In that case, you should try to get to the targeted point though “Dorsal Approach”.

In the process of “Dorsal Approach”, you should be careful not to touch nerve roots.

Q5. Why the view by the endoscopic cable is not clear at the beginning of procedure?

You may inject the saline to clean the view or you may use the laser fiber to remove a thing which interference with the clean view or you may steer the catheter to remove a thing which interferes with the view.

 You may face the unclear view although you are using the new endoscopic cable.

 In that case, the above 3 ways may be also applicable.

  Stryker's HD1188 model is found to have the best compatibility with our endoscopic cable.

Q6. How to deal with Patient’s pain during the saline injection?

Patients are in a variety of proper saline amount although clinical paper says that 200cc of saline is appropriate.

For example, a patient after 400cc saline injection does not complaint of any pain while a patient after only 150cc saline Injection does complaint of a pain.

Regardless of which case between two patients, You should stop injecting the saline as long as the patient complaints of a pain.

When the patient after the certain amount of saline injection may appeal on some pain from its shoulder or neck or eyes, you are requested to do the following steps;

l  The patient neck placement should be up

l You should remove the cap of the hose from the catheter to release the saline

Q7. If the View is still unclear?

If the view which you wants is not still obtained,

Firstly, try to guess the bulging location according to AP view from MRI & lateral view from X-ray.

Then, stimulate the guessed bulging area to obtain the space for the view.

Q8. How to judge either ventral side or dorsal side?

The upper above the shape of the crescent moon is the ventral side and the lower is the dorsal side.

Q9. How/why should you stimulate before the laser shooting for the treatment?

The simulation is required to make sure of the safe laser shooting for the treatment.

In the case of Holmium Laser, do the simulation in 2.5watt.

During the stimulation, If you shoot the bone, the patient will feel a twinge in its leg.

If you shoot the nerve, the patient’s leg will bounce and complaint about a pain.

If you shoot the disc, the patient does not complain and you shoot the laser for the treatment.

Q10. How shoot the laser after the stimulation?

You should shoot the laser for the treatment in 5watt ~ 8watt.

The short interval of the laser shooting is required than the long interval of the laser shooting with checking the patient’s status.

Q11. When should SELD be stopped?

You are requested to stop SELD when the view full of the disc is clear after removing the disc by the laser,

Q12. What is difference between PELD & SELD?

§ PELD is through “lateral approach” while SELD is through “Hiatus approach”.

     (When a bulging disc is located at the place which is hard to be reached by the catheter,

      PELD can be the best option.)

§  SELD is more micro invasive than PELD.