Anatomical Enucleation of the Prostate with Thulium:YAG Support: Redefinition of the Surgical Approach in Two-Lobe Technique

Abstract

Introduction:

Transurethral resection of the prostate (TURP), vaporization or complete removal of the transitional zone by transurethral enucleation of the prostate (TUEP) are viable surgical options for bladder outlet obstruction secondary to benign prostatic hyperplasia. ^{1 –25} TURP using high-frequency current has been considered the standard of care. ^8,12 The concept of TUEP in general and anatomical “cold” dissection has gained attention especially since the end of the 2000s with the introduction of novel energy sources. In 2010, we presented our technique of transurethral anatomical enucleation of the prostate with Tm:YAG support (thulium-laser-enucleation of the prostate [ThuLEP]) as a blueprint for TUEP techniques. ¹¹ Anatomical TUEP offers complete removal of prostate adenoma and can be performed with any energy source: that is, bipolar or monopolar power as well as laser sources.

Material and Methods:

In this video we present our technique of anatomical TUEP with Tm:YAG support (ThuLEP) in a two-lobe manner as an evolution of the original technique after 6 years of procedural optimizing and teaching of the procedure. Major surgical steps are U-like inverted incision close to the verumontanum, mechanical exposure of the surgical capsule, detachment of the left lobe using combined mechanical force and incision by a 2 µm continuous wave Tm:YAG laser, en bloc detachment of the right and median lobe, and removal of prostatic tissue by mechanical morcellation.

Results:

The presented evolution of the ThuLEP technique is feasible and perioperative and functional results are in line with published data for the three-lobe technique.

Conclusion:

We display a novel technique for complete removal of the transitional zone of the prostate using ThuLEP in a two-lobe manner.

No competing financial interests exist.

Runtime of video: 9 mins 13 secs