Holmium Laser Enucleation of the Prostate (HoLEP): A Technical Update

Ramsay L Kuo, Ryan F Paterson, Samuel C Kim, Tibério M Siqueira Jr, Mostafa M Elhilali, James E Lingeman, Ramsay L Kuo, Ryan F Paterson, Samuel C Kim, Tibério M Siqueira Jr, Mostafa M Elhilali, James E Lingeman

Abstract

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH). Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. The learning curve remains an obstacle, preventing more widespread adoption of this procedure. This paper provides an outline of the HoLEP technique as is currently used at two centers in hopes of easing the initial learning curve. TECHNICAL CONSIDERATIONS: Detailed descriptions of the major steps of the HoLEP procedure are provided with attention to critical steps such as identification of the surgical capsule, median and lateral lobe enucleation, and morcellation of enucleated tissue. CONCLUSIONS: HoLEP is a promising alternative for the surgical treatment of BPH which allows complete removal of intact lobes of the prostate. Obstruction is relieved immediately with superior hemostasis, no risk of TUR syndrome, and a minimal hospital stay.

Figures

Figure 1
Figure 1
Sulci between median and lateral lobes (at 5 and 7 o'clock)
Figure 2
Figure 2
Appearance of proximal surgical capsule
Figure 3
Figure 3
Appearance of left apical pad
Figure 4
Figure 4
Dissection of plane between anterior surgical capsule and adenoma
Figure 5
Figure 5
Appearance of mucosal strip (to left)
Figure 6
Figure 6
Use of resectoscope beak to leverage adenoma upward
Figure 7
Figure 7
Morcellator inserted into offset nephroscope

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