HoLAP vs. HoLEP
A review of the pros and cons of each procedure can help physicians decide which procedure suits them best. The truly unique benefit of the holmium laser is that both procedures are available for surgeon adoption.
| |
HoLAP |
HoLEP |
| Pros |
Superior treatment with few complications
Easy to learn and master
Proven durability
Excellent starting procedure for HoLEP
Single use fiber convenience
|
Superior treatment with few complications
Most rigorously investigated and proven technique
Proven durability
Multiuse fiber cost effectiveness
|
| Cons |
No tissue for histology
|
Longer learning curve
|
Holmium is the ideal laser for BPH treatment. Holmium state-of-the-art procedures have the largest body of clinical evidence showing superiority over other surgical technologies and techniques. Treating with holmium is clearly the best choice for physicians and patients!
Holmium BPH Treatment vs. TURP
HoLEP (prostate enucleation) is the state-of-the-art procedure that is the superior alternative to traditional TURP and open prostatectomy. HoLAP (prostate ablation) is a superior alternative to the traditional TURP, has a short learning curve and few if any complications.
| |
HoLAP
Holmium Ablation of Prostate |
HoLEP
Holmium Enucleation of Prostate |
TURP
Transurethral Resection of Prostate |
| Technique |
Tissue vaporization
|
Tissue enucleation and morcellation
|
Tissue resection
|
| Catheter time |
Less than 24 hrs
|
Less than 24 hrs
|
Few days
|
| Hospital stay |
Less than 24 hrs
|
Less than 24 hrs
|
Few days
|
| TUR syndrome |
No
|
No
|
Possible
|
| Transfusions |
No
|
No
|
5-10%
|
| Anticoagulated pts treated on therapy |
Yes
|
Yes
|
No
|
Holmium Ablation vs. Green Light PVP
HoLAP and green light photoselective vaporization procedures have a number of similarities. However, the holmium laser has substantial advantages when compared to green light. The following table compares the two systems and procedures.
HoLAP vs. PVP
| |
VersaPulse PowerSuite HoLAP
(Holmium Ablation of the Prostate)
|
GreenLight PV PVP™
(Photoselective Vaporization of the Prostate)
|
Lumenis Advantage |
| Wavelength |
2120 nanometers
Absorbed by water
(main tissue component)
|
532 nanometers
Absorbed by pigment
hemoglobin)
|
More versatile and cost effective surgical solution for multiple applications including BPH, stones, tumors, strictures and other applications
|
| Tissue treatment |
Pulsed holmium used near or in contact with tissue
|
Continuous wave green light used near but not in contact with tissue
|
Easier and more familiar contact technique
|
| Penetration depth |
0.5 mm
|
1-2 mm
Beyond visible surface
|
Eliminates concern about damage to surrounding tissue and delayed sloughing caused by deep coagulation
|
| Tissue effect over time |
Superficial vaporization even if fiber efficiency decreases during normal use
|
Fiber degradation can lead to deep coagulation when vaporization is no longer present, increasing risk of retention, severe dysuria and delayed sloughing of necrotic tissue
(Footnote 4)
|
Eliminates concern about damage to surrounding tissue and deep coagulation
Eliminates potential for undesirable patient complications
|
| Surgical outcome |
Immediate symptom relief with few patient complications
|
Immediate symptom relief with few patient complications when excessive tissue coagulation does not occur
|
Better patient satisfaction
|
| Tissue removal |
1 – 2 grams/ minute
|
1 – 2 grams/ minute
|
No slowing of tissue removal due to deep coagulation vs vaporization effect
|
| Electrical requirements |
30 amp , 220V
|
50 amp, 220V
|
No expensive electrical rewiring needed
|
| Cooling requirements |
Self contained water to air system
|
Requires hook up to external water source
|
No outdated water cooling or unwieldy OR hook ups needed
|
| Scope camera modification |
None required
|
Requires adapter that fogs and makes visualization difficult
|
Better visualization
Clearer field of view
|
| Fiber card |
None required
|
Requires fiber card insertion prior to operation
|
No hassles with unnecessary fiber cards
|
| Safety eyewear |
Clear
|
Produces orange field of view
|
Clearer field of view
Easier to see and treat bleeding
|
| Delivery device |
DuoTome side fire
|
Side fire
Must wipe tip clean when debris accumulates (Footnote 5)
|
No fiber tip cleaning needed during case
|
Endoscopic Equipment for HoLAP
Examples of endoscopic equipment that may be used for HoLAP are provided below. A 22-28 French continuous flow resectoscope and inner sheath with fiber stabilization guide to accommodate the Duotome fiber maximum outer diameter of 7.2 French is required.
| Manufacturer |
Number |
Description |
| Karl Storz |
27005BA
|
Hopkins II Telescope, 30° or
|
|
27005FA
|
Hopkins II Telescope, 12°
|
|
27050SL
|
Rotatable 26Fouter sheath and inner sheath or
|
|
27040SL
|
Non-rotatable 26F outer sheath and inner sheath
|
|
27050FL
|
7.5F laser fiber bridge
|
| ACMI Elite |
CLS-23
|
Outer sheath
|
|
CLB8-23
|
Laser fiber bridge
|
|
CLO-23
|
Obturator
|
| Olympus |
A22002A
|
OES Pro Telescope, 30° or
|
|
A22001A
|
OES Pro Telescope, 12°
|
|
A22026A
|
OES Pro CRF 26F rotatable outer sheath or
|
|
A22021A
|
OES Pro CRF 27F rotatable outer sheath
|
|
A42091A
|
OES Pro ABS, CRF 8F Working insert
|
|
A2296
|
22.5F outer sheath
|
| Discontinued |
A2297
|
Inner sheath with 9F channel
|
|
A2621
|
OES-4000 CRF 27F rotatable outer sheath
|
|
A4725
|
OES-4000 ABS working insert, 8F working channel
|
