Thulium fiber laser enucleation of the prostate

Abstract

Objective: The new thulium fiber laser became available in North America over thepast year. The study aim of this video is to demonstrate in a stepwise approach the method ofperforming a thulium fiber laser enucleation of the prostate (TFLEP). Patients and surgical procedure: TFLEP is indicated for men with bothersome lowerurinary tract symptoms who have evidence of bladder outlet obstruction. Gland sizecan be any size (>30grams). The patient in this video is a 72 y.o. gentleman with a past medical history of hypertension. He had failed 2 trial of voids and was catheter dependent. His prostatewas estimated to be 153.4 grams on MRI. Results: Using the new thulium fiber laser, enucleation of the prostate can besuccessful performed. As seen in the video, there is minimal bleeding and minimal carbonization of the tissue using the no touch technique.Settings include 1J and 60Hz with the short pulse for enucleation and 1J and 30Hz with the long pulse for hemostasis. Enucleation time was 45 mins and morcellation time was 13 mins. Urine was clear in the recovery room and the patient went home with his catheter 4 hours post-surgery. Conclusions: The key to using this new laser for enucleation of the prostate, includes avoiding direct contact with the tissue as this will minimize carbonization. The main advantages of this new laser for enucleation of the prostate are exceptional hemostasis and excellent tissue separation. Future studies should compare this new laser with others that are currently available for prostate enucleation.