V3-13: THULIUM VAPOENUCLEATION OF THE PROSTATE: SURGICAL TECHNIQUE FROM VAPORIZATION TO VAPOENUCLEATION

V3-13: THULIUM VAPOENUCLEATION OF THE PROSTATE: SURGICAL TECHNIQUE FROM VAPORIZATION TO VAPOENUCLEATION

Video

Introductions and Objectives
Thulium vapoenucleation of the prostate (ThuVEP) is a minimally invasive, size-independent transurethral procedure for symptomatic benign prostatic enlargement (BPE). We have shown ThuVEP may be safely applied to almost all patients, and provides results similar to open prostatectomy and transurethral resection of the prostate. The aim of this video is to teach the steps necessary to execute ThuVEP safely.

Methods
In this educational video we detail our surgical technique for ThuVEP and include advice on how to avoid complications. We emphasize a tested, systematic surgical learning algorithm beginning with vaporization, advancing to vaporesection, and ultimately progressing to vapoenulceation.

Results
Our prior work has shown that by following the presented learning algorithm, proficiency at ThuVEP is attainable after 15 mentored-assisted cases, and even applies to urology residents with limited prior transurethral experience. In a review of 1080 patients undergoing ThuVEP between 2007 and 2012, median prostate volume was 51 ml (36 โ€“ 79 ml) with 25% of the prostate volumes larger than 80 ml, median enucleation time was 32.5 minutes (22 โ€“ 50 min), median total operation time was 56 minutes (40 โ€“ 80 min), Clavien 3 or higher complications occurred in 72 (6.7%) patients, and 18 (1.7%) patients received a blood transfusion.

Conclusions
The learning algorithm presented for ThuVEP is safe and effective, and allows the trainee to gain surgical proficiency in a reasonable timeframe. Once surgical proficiency is achieved, ThuVEP should be considered a viable treatment option in all patients with symptomatic BPE, including those on anticoagulation and those with massive prostates.

Funding: August Kurten Foundation