Thulium Vapoenucleation of the Prostate: Surgical Technique from Vaporization to Vapoenucleation

Abstract

Introduction:

Thulium vapoenucleation of the prostate (ThuVEP) is a minimally invasive size-independent transurethral procedure for symptomatic benign prostatic enlargement (BPE). We have shown that ThuVEP may be safely applied to almost all patients and provides results similar to open prostatectomy and transurethral resection of the prostate. ^{1 –6} The aim of this video is to teach the steps necessary to execute ThuVEP safely.

Materials and Methods:

In this educational video, we detail our surgical technique for ThuVEP and include advice on how to avoid complications. We emphasize a tested systematic surgical learning algorithm beginning with vaporization, advancing to vaporesection, and ultimately progressing to vapoenulceation.

Results:

Our previous work has shown that by following the presented learning algorithm, proficiency at ThuVEP is attainable after 15 mentored-assisted cases and even applies to urology residents with limited previous transurethral experience. In a review of 1080 patients undergoing ThuVEP between 2007 and 2012, the median prostate volume was 51 mL (36–79 mL), with 25% of the prostate volumes larger than 80 mL, the median enucleation time was 32.5 minutes (22–50 minutes), the median total operation time was 56 minutes (40–80 minutes), Clavien 3 or higher complications occurred in 72 (6.7%) patients, and 18 (1.7%) patients received a blood transfusion.

Conclusions:

The learning algorithm presented for ThuVEP is safe and effective and allows the trainee to gain surgical proficiency in a reasonable timeframe. Once surgical proficiency is achieved, ThuVEP should be considered a viable treatment option in almost all patients with symptomatic BPE.

This work was presented at the 2014 WCE

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This work was funded by August Kurten Foundation

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No competing financial interests exist.

Runtime of video: 6 mins 57 sec