Presentation Authors: Nicholas Kavoussi*, Nicole MIller, Nashville, TN
Introduction: Holmium laser enucleation of the prostate (HoLEP) has become a therapeutic mainstay for prostatic obstruction, particularly for larger glands. The technique has been found to be durable and effective despite some limitations such as operative time and learning curve. The Moses laser fiber produced by Lumenis (Yokneam, Israel) is a novel technology that provides more efficient energy delivery to a target structure by decreasing water absorption of the beam. Though prior research has shown benefit of the technology as applied to stone surgery, there have been no reports of utilizing the Moses laser for prostatic enucleation. We sought to subjectively evaluate Moses laser enucleation of the prostate (MoLEP) as a novel alteration to HoLEP.
Methods: Prostatic enucleation was performed in a single patient by a single surgeon. The prostate was removed in two sections, divided by left and right prostatic lobes. Traditional holmium laser was used for the patientâ€™s right lobe, while the Moses technology was applied to the left. Subjective evaluation of the Moses laser was compared to traditional holmium laser for four critical steps of the procedure: mucosal incision, enucleation, vaporization, and hemostasis.
Results: Moses technology was found to be feasible and effective for prostatic enucleation. In this single patient, mucosal incision and enucleation showed some possible increased separation of tissue, though the technique was at least equivalent to traditional HoLEP. Notably, MoLEP provided for a perceived increase in tissue vaporization and hemostasis. Overall, the surgical procedure was successful and patient progressed well postoperatively, passing a voiding trial on the first postoperative day.
Conclusions: MoLEP is feasible and effective as a treatment for benign prostatic hypertrophy. Technically, it seems to be at least equivalent to traditional HoLEP in terms of mucosal incision and enucleation with some advantages in tissue vaporization and hemostasis. More studies required to evaluate both operative and clinical outcomes, as well as how the technology may impact learning curve.