Mini-invasive treatment of benign prostatic hyperplasia: an optimized transurethral laser enucleation of prostate with an innovative double wavelenght Thulium laser (ThuLEP)

Abstract

Transurethral removal of prostatic tissue is the treatment choice for symptomatic BPH with bladder outlet obstruction (BOO). Various laser devices have been introduced in clinical practice, showing good results. The aim of this video is to present a novel technique of complete transurethral removal of the transition zone (enucleation) with the support of a new Thulium laser device, which is able to combine and optimize cutting and coagulation at a different wavelenghts (Thulium 1940nm and Diode 1470 nm). We present distinct surgical steps in chronological order with the help of intraoperative pictures for transurethral complete removal of the transition zone of the prostate (ThuLEP). Thulium laser energy of 60 W at 1940nm were used for the incision at the verumontanum, anterior commissura and bladder neck, whereas laser energy of diode 30 W at a 1470 nm) was only used for coagulation of small vessel. The lobes themselves are liberated by blunt dissection and finally morcellated or resected with monopolar.
Optimized ThuLEP represents an innovative option in patients with BPH. It is a size independent surgical endoscopic technique with a low complication rate.The use of a double wavelenght laser improves the coagulative effects of the laser.