The Technique of Holmium Laser Resection in the Larger Prostate (HoLRP)
Chilton C

INTRODUCTION: The development of the 80-watt Holmium laser has enabled a bloodless endoscopic resection of the prostate to be possible. The surgical technique is the key to the procedure, and being able to adapt it to resecting larger glands (50g).

MATERIALS AND METHODS: The video uses simultaneous transmission of computer designed graphics, the endoscopic views of the resection and views of the operator to show the hand/instrument position used to keep the fibre applied to the tissue. As good vision is vital, a continuous flow resectoscope, modified to take the laser fibre within a ureteric catheter, and an endoscopic camera are essential. Two bladder neck incisions are made down to the capsule from the trigone to the veru at 5 & 7 o'clock. Joining these two incisions above the veru enables the middle lobe to be dissected back to the bladder neck. Similar BNI's are made either side of the midline at 12 o'clock back to the veru. Joining the 5 & 12 o'clock incisions at veru level enables the whole lateral lobe to be enucleated off the capsule back to the bladder neck. This tissue is reduced in size before being cut off into the bladder. The pieces are evacuated and a 2-way 20CH silicone catheter is inserted.

RESULTS: This technique results in a typical "TURP" cavity without bleeding. No cases of TUR syndrome or perioperative death have been reported. The outcome in reduction of symptom scores and improvement in flowrate are equivalent to TURP with a shorter hospital stay and convalescence.

CONCLUSIONS: Holmium laser resection of the larger gland is possible and practical.

Journal of Endourology, Vol. 13 Supplement 1, A149 Sep 1999

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