Holmium laser enucleation of the prostate (HoLEP) is now expected to replace transurethral resection of the prostate (TURP) as the gold standard surgical treatment of benign prostatic hyperplasia (BPH). HoLEP was first reported by Gilling et al. in 1998, the setting of the laser was accomplished by the high-power of 80W (2.0 J and at a frequency of 40 Hz). Therefore, it is mainstream now to use high-power holmium laser more than 80W for HoLEP, it will be the present recognition that is difficulty with the low-power holmium lasers. The high cost of the high power laser is considered one of a factor inhibiting the propagation of HoLEP. If it is recognized that HoLEP is possible with a low-power laser, the cost of introducting HoLEP can be reduced and it could become a more standard surgery. Therefore, we introduce our experience of the HoLEP with Quanta Litho 30W low-power holmium laser with en-bloc technique.
Between May to September 2017, 23 patients with benign prostatic hyperplasia underwent HoLEP with en-bloc technique using Quanta Litho 30W laser. The enucleation process was performed with the laser set 1.5 J and at a frequency of 15 Hz, hard stone mode. 15 patients were operated by surgeon1 who has performed over 200 HoLEP operations, and 8 patients were performed by surgeon2 with around 40 HoLEP operation experience. We evaluated the surgical parameters, including total operative time, enucleation time, morcellation time, total energy, and hemoglobin loss.
The mean age and mean preoperative estimated prostate volumes were 75.0 (58-89) years and 92.9 (40-216) mL, respectively. The mean total operating time, mean enucleation time, and mean morcellation time were 86.1 (35-154), 39.1 (21-74), and 20.6 (2-73) minutes, respectively. The mean total energy was 37.62 (22.85-66.89) kJ. Mean hemoglobin loss was 1.06 (0-2.5) g/dL. None of the patients needed blood transfusion during the postoperative period. Intraoperative complications such as capsular perforation and bladdermucosal injury did not occur in all patients.
HoLEP with en-bloc enucleation technique can be performed without any safety and technical problem with Quanta Litho low-power holmium laser. Thus, this low-power holmium laser was thought that it was necessary and sufficient on performing HoLEP. Furthermore, cost of the HoLEP introduction can decrease if it performs HoLEP with a low-power laser. We believe that the hemostatic capacity of low power holmium lasers is limited for excessive bleeding, so, combined hemostasis with a bipolar electrode should be considered.