Top-down thulium fiber laser enucleation of the prostate: technical aspects.
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ABSTRACT:
SUBMITTER: Elmansy H
PROVIDER: S-EPMC8318026 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.
| S-EPMC3773585 | biostudies-literature
Project description:BackgroundTo assess the educational value of YouTube surgical videos of thulium laser enucleation of the prostate (ThuLEP).MethodsA comprehensive search of "ThuLEP" or "thulium laser enucleation of the prostate" was performed on YouTube on October 31, 2020. According to the LAParoscopic surgery Video Educational GuidelineS, we created a checklist to assess the educational value of these videos. The checklist included 20 options. Each option represented one point. The total score was the sum of all the points. The higher score represents the higher educational value.ResultsA total of 70 videos were included. The average number of views were 1,366 (range, 11-30,884). The mean video length was 16.59 mins (range, 1.20-70.35 mins). Only 22.9% (16/70) videos had audio or/and written commentary in English language. Although 67.4% (47/70) videos were present step by step, only 21.4% (15/70) videos did the detailed explanation of critical steps. The mean score of the videos was 5.5 points (range, 1-15). No videos met all the points of the checklist. The mean percentage conformity of the videos was 28% (range, 5-75%). The educational score of the videos had no significant positive correlation with the number of views.ConclusionsThe majority of ThuLEP videos on YouTube platform have low educational value. Videos often lack important and detailed explanations about surgical procedures. The ThuLEP learner should watch these videos selectively. These findings remind us that a global effort should be made to improve the educational value of YouTube surgical videos, and more reporting guidelines about urological endoscopic surgery are still needed.
| S-EPMC8350234 | biostudies-literature
Project description: Not available
| S-EPMC7848832 | biostudies-literature
Project description:The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here.From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate.The mean operative time was 82.1±33.3 minutes. The mean enucleation time and morcellation time were 52.7±21.7 minutes and 8.2±7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9±24.6 g and 0.4±0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively.The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.
| S-EPMC4643173 | biostudies-other
Project description:BACKGROUND:The efficacy of thulium laser prostate enucleation (ThuLEP) for large prostates is unclear. This study aimed to explore the expanded utility of 150-200-W ThuLEP by studying patients with a large prostate (>?80?mL). METHODS:We retrospectively reviewed records of 125 patients with large prostate glands (>?80?mL) who underwent ThuLEP performed by a single surgeon from June 2012 to June 2016. The ThuLEP data from our previous pilot study were used as the control. Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume, and the international prostate symptom score (IPSS) were recorded and analyzed using Student's t-test, the z-test, and logistic regression analysis. RESULTS:Of 366 patients who underwent ThuLEP, 125 (34.15%) were enrolled. The ages and estimated prostate volumes were compared with those of the control. Overall, 39.2% underwent Foley placement and 4% received an anticoagulant agent preoperatively. Maximum urinary flow rates before and 3 and 12?months postoperatively were 9.93, 23.20, and 19.00?mL/s, respectively, which were generally equal to those of the control groups (P =?0.68, 0.18, 0.98, respectively). Preoperative and postoperative IPSSs were 27.09 and 7.35, respectively. The postoperative prostate-specific antigen was reduced by 85.59% in comparison to the preoperative level. The estimated prostate size was reduced by 74.17% postoperatively. The modified Clavien-Dindo classification system was used to identify the overall rate of complications, which was approximately 22.4%. The mortality rate was 0.8%. CONCLUSIONS:High-power ThuLEP is safe and effective for patients with large prostate glands (>?80?mL). Prostate enucleation using a high-power thulium laser is feasible for patients who exhibit contraindications for surgery.
| S-EPMC6341629 | biostudies-literature
Project description:Holmium laser enucleation of the prostate (HoLEP) has been accepted as the most efficient method of transurethral surgery for benign prostatic hyperplasia. The originally developed three-lobe technique has popularized this surgery; this method is based on three longitudinal incisions, by which the median lobe is removed, and subsequently, both lateral lobes are enucleated. To maintain a consistent surgical plane and to minimize sphincteric damage, the traditional three-lobe technique is continuously being refined and evolving. A few modifications of the original technique have been developed, and several en bloc enucleation methods have been introduced. However, more clinical evidence is required to show the superiority of newer techniques over the original three-lobe technique in terms of efficacy and long-term side effects. To date, none of the newer techniques have been accepted as a standard technique for HoLEP.
| S-EPMC6722407 | biostudies-literature
Project description:BackgroundTo evaluate preoperative predictors of enucleation time during en bloc 'no-touch' holmium laser enucleation of the prostate (HoLEP) METHODS: We enrolled 135 patients with symptomatic benign prostatic hyperplasia (BPH) treated with en bloc 'no-touch' HoLEP from July 2017 to March 2019 by a single surgeon. Preoperative, perioperative, and postoperative clinical variables were examined. Stepwise linear regression was performed to determine clinical variables associated with enucleation times.ResultThe average (range) enucleation time was 46.1 (12-220) minutes, and the overall operation time was 71 (18-250) minutes. History of antiplatelet agents, history of urinary tract infection (UTI), and increasing specimen weight were each significantly associated with increasing enucleation time. No category IV complications were recorded, and all complications were evenly distributed among the groups according to the HoLEP specimen weight.ConclusionEn bloc 'no-touch' HoLEP was found to be an efficient and reproducible surgical method for treating BPH. Prostatic gland size was significantly associated with increased enucleation times. Similarly, history of UTI and antiplatelet agents were correlated with increased operative time.
| S-EPMC7661272 | biostudies-literature
Project description:The aim of this study was to evaluate the usefulness of a thulium-doped fiber laser and a diode laser in zero ischemia kidney surgery, by carrying out a comparative study in a pig model. Research was carried out on 12 pigs weighing 30 kg each. A thulium-doped fiber laser (TDFL) and a diode laser (DL) operating at wavelengths of 1940 and 1470 nm, respectively, were used. The cut sites were assessed both macroscopically and microscopically. The zone of thermal damage visible in the histopathological preparations was divided into superficial and total areas. During partial nephrectomy, moderate to minimal bleeding was observed, which did not require additional hemostatic measures. All animals survived the procedure. On day 0, the total thermal damage depth was 837.8 µm for the TDFL and 1175.0 µm for the DL. On day 7, the depths were 1556.2 and 2301.7 µm, respectively. On day 14, the overall thermal damage depth for the DL was the greatest (6800 µm). The width of the superficial zone was significantly reduced on days 7 and 14 after TDFL application. Both lasers are suitable for partial wedge nephrectomy without ischemia in pigs. The TDFL produced similar or better hemostasis than the DL, with a smaller zone of thermal damage and, therefore, seems more suitable for application in human medicine.
| S-EPMC8073520 | biostudies-literature
Project description:ObjectiveTo demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely.MethodsEnucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance.ResultsThe distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder.ConclusionThis video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.
| S-EPMC8021387 | biostudies-literature
Project description:A stable dual-wavelength thulium-doped fiber laser operating at 1.9 μm using a short length of photonic crystal fiber (PCF) has been proposed and demonstrated. The photonics crystal fiber was 10 cm in length and effectively acted as a Mach-Zehnder interferometry element with a free spectral range of 0.2 nm. This dual-wavelength thulium-doped fiber laser operated steadily at room temperature with a 45 dB optical signal-to-noise-ratio.
| S-EPMC4600979 | biostudies-other