Korean J Urol.  2013 Sep;54(9):570-579.

Technical Aspects of Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

• Kim M
• Lee HE
• Oh SJ

Abstract

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.

Keyword

Holmium laser enucleation of the prostate; Morcellation; Prostate surgery; Prostatic hyperplasia; Surgical procedure

MeSH Terms

Holmium
Lasers, Solid-State
Learning Curve
Prostate
Prostatectomy
Prostatic Hyperplasia
Holmium

Figure

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  FIG. 1 Two different types of working channels for holmium laser enucleation of the prostate. (A) An Iglesias type resectoscope. (B) A conventional laser fiber stabilizing bridge.

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  FIG. 2 Hand manipulation for holmium laser enucleation of the prostate. (A) Enucleation. (B) Morcellation.

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  FIG. 3 The three-lobe or four-lobe technique. Step A, initial incision; step B, transverse incision for median lobe enucleation; step C, upward enucleation of both lateral lobes; step D, longitudinal incision of the anterior lobe (12 o'clock position); step E, downward enucleation of both lateral lobes; step F, completion of lateral lobe enucleation; step G, anterior lobe removal during the four-lobe technique.

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