Surgical Approach for Coring with Shaeer's Cavernotome
For excavation of corporal fibrosis with Shaeer’s Cavernotome, surgery is performed through a peno-scrotal incision with an indwelling urethral catheter. The scrotal septum is brought down to expose the crura. Corporotomies are incised, 2-5 cm long, according to the implant intended; whether inflatable or malleable. A core of fibrous tissue is sharply excised with scissor or scalpel, approximately 2 cm long, right underneath the corporotomy. This is to make space for introduction of Shaeer’s Cavernotome, as well as to test the maximum girth of Shaeer’s Cavernotome that will fit in. Selecting that maximum girth of Shaeer’s Cavernotome from the start will allow one-step cavernotomy and dilatation, obviating the need for further excavation.
Distal Coring with Shaeer's Cavernotome
The distal corpora are cored first. The urethra is identified by the catheter. Shaeer’s Cavernotome is introduced through the corporotomy pointing distally, and is lodged against the fibrous tissue. The assistant pulls on the stay sutures in the counter-direction to help lodging. The corpus cavernosum is held between the thumb and index fingers of the non-dominant hand right above the tip of Shaeer’s Cavernotome, with the intention of checking the position of the tip throughout the process and to stretch and straighten the corpus above the advancing tip. The dominant hand grabs the rear handle. Coring proceeds:
Shaeer’s Cavernotome is rotated clock-wise, while slowly advancing forwards in millimeter increments. The non-dominant thumb and index advance ahead of the tip. The direction of coring is central, along the vertical axis, parallel and lateral to the urethra. This is contrary to the customary lateral direction when blunt dilators are used. The non-dominant thumb and index fingers check this orientation at all times. The thumb pushes the spongiosum aside. Coring stops shortly before the tip of the corpus cavernosum.
Coring the distal fibrous tissue takes approximately one to two minutes per corpus cavernosum. Following coring, the corpora are sized as regards length with the numerical markings on Shaeer’s Cavernotome. Blunt dilators can be used to calibrate and maximize girth. The corpora are flushed with antibiotic solution.
Shaeer’s Cavernotome is withdrawn and demolished fibrous tissue is pushed out of it using a straight obturator provided. The same process is repeated on the contralateral side
Coring leaves behind a thin strand of fibrous tissue that can be pulled out and severed at the tip. However, this is unnecessary, since in our experience, the strand will not prevent easy insertion of the maximum girth Hegar.
Proximal Coring with Shaeer's Cavernotome
Shaeer’s Cavernotome is re-introduced into the corporotomy pointing proximally and sideways along the direction of the crus. The non- dominant index or thumb finger is laid over and along the crus to act as a guide for direction of advancement and to identify the proximal tip / bone . Both can also pinch the crus ahead of Shaeer’s Cavernotome’s tip as with distal coring. Coring proceeds as described earlier. Stretching and straightening the crura straight by pulling on the stay sutures or the penile shaft is very important, to avoid side-perforation.
Advancement stops before the proximal tip which is identified by the non-dominant index finger, as well as by the “bounce-test”. The bouncing test is whereby Shaeer’s Cavernotome is repeatedly pushed and pulled gently for a very short distance towards the bone. If it bounces, then coring should proceed further. It is does not or if it bounces for a very short distance, then we have hit-bone and coring is deemed sufficient. Sizing and flushing are performed, followed by coring the contralateral crus. In trained hands, coring each crus takes one to three minutes.