V5-08: "TOP-DOWN" HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HoLEP) TECHNIQUE
In this video, we demonstrate our version of the novel anterior-posterior HoLEP dissection technique.
Video of the surgical technique accompanied by slides and voiceover explanation of the steps
A novel anterior-posterior HoLEP dissection technique allows faster operation time and potential continence improvement. We demonstrate our version of this technique and present early operative outcomes. After cystoscopy a posterior groove is created at the 6 o'clock position in a bilobar gland. If there is a prominent median lobe the groove is cut at either 5 or 7 o'clock. The groove is extended to the veramontanum and to depth of capsule. The edges of the lateral lobes on either side of the veru are incised. The scope is rotated to visualize the anterior commissure and retracted to identify the edge of the lateral lobes and the sphincter. The anterior commissure is then incised at 2 Joules/20 Hz Setting. The dissection plane is located anteriorly with a series of short incisions. We identify this plane on both sides at this point as it can be difficult to find it later once a lateral lobe is completely resected on one side._x000D_ _x000D_ Once the plane is apparent, lateral lobe dissection is begun. The lateral lobe is dissected from the top down, allowing faster dissection time than the traditional technique. The mucosal strip is easily visualized as the apical dissection is performed from top down. This eliminates the need to encircle the mucosal strip reducing enucleation time. Given sphincter proximity, 2 Joules/20 Hz laser setting is again used. Once the entire lobe dissection is completed, the lobe is pushed into the bladder. The residual cavity is inspected and hemostasis controlled. Finally, tissue is morcellated with a Wolf PIRANHA instrument. _x000D_ _x000D_ Retrospective review of HoLEPs from December 2015 to April 2016 was performed. 49 patients who underwent anterior posterior technique were compared with 37 who underwent traditional posterior to anterior enucleation. Mean enucleation time and mean enucleation rate were both faster with the novel, top-down approach. _x000D_
We demonstrate a novel top-down HoLEP enucleation technique with promising early operative results.