HoLAP (Holmium Laser Ablation of the Prostate)

HoLAP is a safe, effective and relatively bloodless procedure for immediate resolution of BPH symptoms. It is easy to learn and can be performed in less than an hour in an outpatient setting with few if any patient complications. Surgeons can quickly master the procedure, minimize OR time and use a familiar technology with which they are comfortable. Patients experience few complications including no blood loss, no transfusions, no catheters after release and a quick return to normal activity. Facilities enjoy the economic benefits of utilizing a multipurpose system for many applications.

HoLAP versus KTP

The KTP laser procedure for treating BPH is referred to as green light PVP or Photoselective Vaporization of the Prostate. KTP vaporization is similar to HoLAP, but the KTP wavelength penetrates somewhat deeper. Both techniques are easy to do, provide immediate BPH symptom relief with few or no complications and are attractive outpatient alternatives to TURP. However, there are some key differences:

• The holmium laser is a multiapplication system effective with stones, KTP is not. Lumenis' VersaPulse PowerSuite is the most cost effective and versatile choice for urologists.
• Holmium penetrates superficially, enabling the surgeon to see the entire tissue effect, KTP does not. KTP penetrates deeper, increasing the risk of thermal damage to surrounding tissue.
• For a more detailed description, please review the following white paper that describes holmium versus KTP.

Products

The VersaPulse PowerSuite holmium laser is a multipurpose surgical tool used for many procedures, including vaporization of the prostate. The versatile holmium laser is an ideal choice for BPH treatment because it vaporizes, cuts, coagulates, penetrates tissue superficially AND fragments stones.

Since holmium is pulsed and absorption is only <0.5mm, prostate tissue is vaporized before it can conduct heat. This superficial ‘what-you-see-is-what-you-get’ effect differs from the coagulating effects of Nd:YAG and KTP laser wavelengths that penetrate deeper and extend below the visible surface. The holmium benefit of instantaneous tissue removal is immediate symptom relief. Adverse post-op complications like dysuria, retention and delayed sloughing of necrotic tissue that can occur when KTP and Nd:YAG lasers are used for prostate vaporization are avoided.

FDA Clearance

The Lumenis holmium laser received FDA clearance for surgical ablation and vaporization in 1990. By August 2001 (FDA clearance K011703), additional indications included “…ablation, vaporization, excision, incision and coagulation of soft tissue in medical specialties including urology, urinary lithotripsy, arthroscopy, ENT surgery, gynecological surgery, pulmonary surgery, gastroenterology surgery…holmium laser resection, enucleation, ablation of the prostate (HoLAP), vaporization and excision for treatment of benign prostatic hypertophphy (BPH)”.

Proven Technique

There are a number of ways to treat BPH with the versatile holmium laser. They include bladder neck incision, and prostate ablation, resection and enucleation. The technique of vaporizing, or ablating, the prostate with a side-fire fiber was developed in the early ‘90s. Prostate ablation does not require a morcellator to remove tissue, as does the enucleation procedure. Early ablation results published in 1996¹ show ease and effectiveness, and recent results published in November 2003² show 7 year durability.

¹ Gilling P, et al. The Use of the Holmium Laser in the Treatment of Benign Prostatic Hyperplasia, Journal of Endourology, Vol 10, No 5, October 1996.
² Tan A, et al. Long-term results of high-power holmium laser vaporization (ablation) of the prostate, British Journal of Urology International, 92, 707-709, Nov 2003
Additional references provided in publications.

Physician Testimonials

	Dr. Akhil Das, attending urologist, Northeastern Regional Hospital, Las Vegas "There has been a resurgence in laser ablation of the prostate to treat bladder outlet obstruction secondary to BPH. The question is, which laser to use? The ideal laser should be easy and safe, and useful for a variety of urologic diseases. The holmium laser has been shown to be safe and effective for the treatment of urinary stones, urinary strictures, urothelial tumors and BPH, and is the ideal choice."
	Dr. James Lingeman, Clinical Professor of Urology at Indiana University School of Medicine and Director of Research, Methodist Hospital Institute for Kidney Disease, Indianapolis, IN "HoLAP has proven to be an effective and simple to learn and perform procedure in our hospital. Patients are released within 24 hours with symptoms relieved and are back to normal activities soon afterward. Because the high power holmium laser is used to treat both stones and BPH, two of the most common conditions urologists treat, it is an essential tool in my OR."
	Dr. Peter Gilling, Consulting Urologist at Tauranga Hospital, Tauranga, New Zealand and considered the pioneer in holmium prostatectomy "Ablation is simple to learn and effective in relieving the symptoms and improving flow rates in men with BPH, depending on the size of the channel created."
	Dr. Richard David, Associate Clinical Professor at UCLA School of Medicine "Holmium ablation of the prostate is a quick, safe and effective outpatient resolution of bladder obstruction with excellent outcomes and minimal or no patient complications. In addition to experiencing immediate symptom relief, the patients’ quality of life improves dramatically, a fact that has lead to overwhelming patient acceptance of the ablation procedure."

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