V3-08: Green laser enucleation of the prostate (GreenLEP) “en-bloc technique”
_x000D_ Laser vaporization is an alternative to transurethral resection of the prostate (TURP) for the treatment of small to medium glands. For large prostates (>80ml.) open prostatectomy or Holmium laser enucleation of the prostate (HoLEP) remains the prefered choice of treatment._x000D_ Green laser 'en bloc' enucleation of the prostate (GreenLEP) followed by mechanical morcellation is an alternative enucleation technique developed by Fernando Gomez-Sancha in Madrid, Spain._x000D_ The aim of this video is to demonstrate the GreenLEP technique step-by-step._x000D_
_x000D_ The surgery was performed with a 532-nm lithium triborate laser (GreenLightTM XPS 180W, American Medical Systems, Minnetonka, Minnesota, USA), 2090 side-fire laser fiber at power settings: 80W for cutting, 20W for coagulation and a PiranhaTM morcellation system (Richard Wolf GmbH,Germany) using the Vmax blade._x000D_ Case Report: _x000D_ A 64-year-old patient presented with lower urinary tract symptoms secondary to benign prostatic obstruction with no response to alpha-blockers. The prostate volume was 92 mL, PSA of 2.4 ng/mL, peak urinary flow rate (Qmax) was 8 mL/sec, postvoid residual volumen (PVR) of 150 mL and international prostate symptom score (IPSS) of 22._x000D_ It was decided to proceed with GreenLEP technique in this case._x000D_
_x000D_ The total operative time was 64 minutes, laser time 22 minutes, morcellation time 8 minutes, total energy employed was 52kJ and 73g. of tissue were enucleated (pathology report showed no evidence of prostate cancer)._x000D_ The bladder catheter was removed at 24 hours postsurgery and the patient was discharged 48 hours postoperative without complication. _x000D_ Three months later all the parameters showed significant improvement (PSA: 0.4 ng/mL, IPSS: 4, Qmax: 26 mL/seg and PVR: 20 mL)._x000D_ There was no incontinence or erectile dysfunction as a result of the procedure.
_x000D_ GreenLEP represents a safe alternative enucleation technique for the complete removal of en bloc adenomatous prostate tissue, regardless of gland size, it is particularly advantageous for the treatment of large prostates. _x000D_ Endoscopic laser enucleation of the prostate is feasible with a side-firing fiber. _x000D_ Gentle mechanical dissection allows for an optimal visualization and understanding of the anatomical planes._x000D_ Low energy coagulation (20W) is used against the capsule providing excellent hemostasis. _x000D_ These promising results warrant further studies to assess longterm outcomes._x000D_