The implantation process for the AMS Ambicor^® involves pre-operative preparation, surgery and post-operative care. The surgical procedure usually lasts from 45 minutes to two hours or more, with the length of the hospital stay depending on the condition of the patient.

The Ambicor surgical procedure, which utilizes the penoscrotal approach, follows these steps.

Caution: This information is for general educational purposes only. Refer to Opeating Room Manual and procedure videos for more detailed instructions on this surgical procedure.

Step 1: Make the Incision

Make a 2-3 cm incision through the median raphe of the scrotum at the penoscrotal angle. Some physicians may prefer a high scrotal incision for better proximal corporal access. Then laterally retract the corpus spongiosum to avoid damaging the urethra.

Step 2: Dissection and Corporotomy

Dissect through Dartos fascia and Buck's fascia to expose the tunicae albuginea. Place stay sutures to use as a reference point when measuring the corpora. Make an incision into one of the corpora cavernosa.

Step 3: Dilate the Corpora Cavernosa

Dilate the proximal and distal corpus cavernosum (7-13 mm) to create a space for inserting a penile cylinder. After dilating one corpus cavernosum, incise and dilate the adjacent corpus cavernosum following the same procedure.

Step 4: Measure Corpora and Select Cylinders

Measure each corpus proximally and distally using the Furlow Insertion Tool or AMS Measuring Tool. Follow the formula provided in the Operating Room Manual to select the appropriate cylinder length and number of rear tip extenders. This calculation allows the tubing to extend directly from the corporotomy. Attach the rear tip extenders if needed.

Step 5: Introduce Suture Through the Glans

Thread a pulling suture at the front of the cylinder through a Keith Needle. Load the Keith Needle into the barrel of the Furlow Insertion Tool. Insert the loaded insertion tool into the corporal body and pass the needle through the glans. Grasp needle with a needle holder and pull it completely through the glans. Detach the Keith Needle from traction sutures. Attach a tubing-clad hemostat to the traction sutures to prevent inadvertent retraction through the glans. The sutures now extend through the glans, in preparation for the next step.

Step 6: Insert Cylinders and Close Corporotomy

Inflate the cylinders fully and insert the proximal end of the cylinder. Deflate the cylinder by bending the device and holding it in this position for 6-12 seconds. Position the distal end of the cylinder by pulling the suture. Note: The corporal incision may need to be extended to ensure the input tube exists directly from the corporotomy. Once both cylinders are implanted and tested, inflate them fully to prepare for closing the corporotomy. Place the AMS Closing Tool or other suitable tool over the cylinders to protect them from inadvertent needle damage. Then close the corporal bodies.

Step 7: Insert the Pump

Use the blunt dissection to form a pocket in the most lateral and dependent portion of the scrotum. Insert the pump into the scrotal pocket. The tubing between the pump and the cylinders should not be palpable to the patient.

Step 8: Test Device and Close

After both cylinders and pump are implanted, inflate the prosthesis to check the quality of the erection and deflate to evaluate flaccidity. Close the subcuticular layers and the skin and remove the pulling sutures. Apply a wound dressing. Leave the device partially inflated and tape penis to abdomen overnight. In addition, a drain may be placed for 12 - 24 hours.

Post-Operative Care

After 24 hours, remove the dressing. Cylinders should be completely deflated. Support the penis on the abdomen for four to six weeks to obtain a straight erection.

After the patient has returned home and the swelling from the surgery has subsided, the physician may ask the patient to pull down on the pump located in the scrotum to properly position it. Positioning the pump makes it easier for the patient to locate the pump in the future. The frequency of positioning the pump is up to the physician.

After three to six weeks, the physician may instruct the patient to cycle the device, inflating and deflating the prosthesis several times daily. Four to six weeks post-operatively, the patient may begin using the prosthesis to have intercourse.

A reference copy of the Operating Room Manual is provided below.