V1024: Step by step technique of photoselective vaporization with the Greenlight XPS 180 W laser for prostatic adenomas > 80 cc
VideoIntroduction and Objectives
The Greenlight XPS 180W laser and the MoXy liquid-cooled fiber provide up to 180W lasing energy and increase the surface of tissue treated with the laser beam. When compared with the Greenlight HPS 120W laser, this device increases the vaporization speed and allows the management of prostatic adenomas larger than 80 cc.
For all procedures we used real time transrectal ultrasonography navigation, and a 23 Fr cystoscope with a 30° lens. Vaporization starts at the bladder neck. The first step is the creation of a central channel at the lower power of 120W to create a working space and improve irrigation, then the power can be increased up to 180W and the lateral lobes are lasered from the bladder neck to the veru montanum. _x000D_ Maximal efficiency of vaporization, assessed by bubbles generation, is obtained with a working distance of the laser from the tissue between 1 and 3 mm. _x000D_ At the end of the procedure, lasing energy must be decreased under 100W at the level of bladder neck and near the prostate capsule.
The Greenlight 180W XPS laser provides a faster vaporization when compared with the Greenlight 120W HPS laser.
This device allows the management of patients with prostatic adenomas larger than 80cc, which usually undergo open prostatectomy, in a safe manner and with an acceptable operative time.