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The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique

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Abstract

Background

Holmium laser enucleation of the prostate (HoLEP) is currently considered a safe and effective therapeutic option for the treatment of adenomas of any size. Being considered difficult to learn and to teach, HoLEP is not as diffused as it would deserve. In 2011, we started performing HoLEP reproducing the traditional Gilling’s technique. Case after case, we introduced alterations in the surgical approach, trying to overcome our difficulties and minimize our learning curve.

Materials and methods

We present a detailed step-by-step description of our modified HoLEP technique, developed in Torino, Italy, which we called en-bloc no-touch.

Results

The main steps of the en-bloc no-touch enucleation phase include: (1) the identification of the correct plane between adenoma and capsule only once, at the apex of the left lobe laterally to the veru montanum, extending the incision retrogradely towards the bladder at 5 o’clock; (2) the en-bloc enucleation of a horseshoe-like adenoma, sparing the 7 and 12 o’clock incisions; (3) the use of the beak of the endoscope, gently raising up the lobe from the capsular plane and creating a dihedral angle, crossed by connective bundles put in tension by this movement; and (4) the gradual no-touch lasing of such fibres, exploiting the effects of the plasma bubble at the tip of laser fibre, with no direct energy supply to the capsule.

Conclusions

In our experience, the en-bloc no-touch technique has the potential to ease some difficult intraoperative steps and to improve the learning curve of HoLEP.

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Abbreviations

AUA:

American Urological Association

EAU:

European Association of Urology

BOO:

Bladder outlet obstruction

BPE:

Benign prostatic enlargement

BPH:

Benign prostatic hypertrophy

BPO:

Benign prostatic obstruction

HoLEP:

Holmium:YAG laser enucleation of the prostate

Ho:YAG:

Holmium:yttrium–aluminium–garnet

LUTS:

Lower urinary tract symptoms

TURP:

Transurethral resection of the prostate

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Acknowledgments

Dr. Moises Alberto Mendoza Sotelo, resident from Mexico who attended our Department for six months, helped us preparing a video on this technique, presented at the EAU 2015 Congress of Madrid.

Authors’ contribution

Scoffone involved in project development 50 %, data collection or management 50 %, data analysis 50 % and wrote and edited the manuscript 50 %. Cracco involved in project development 50 %, data collection or management 50 %, data analysis 50 % and wrote and edited the manuscript 50 %.

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Authors and Affiliations

  1. Department of Urology, Cottolengo Hospital, via Cottolengo 9, 10152, Turin, Italy

    Cesare Marco Scoffone & Cecilia Maria Cracco

Authors
  1. Cesare Marco Scoffone
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  2. Cecilia Maria Cracco
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Corresponding author

Correspondence to Cesare Marco Scoffone.

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Conflict of interest

Dr. Cesare Marco Scoffone: consultant for Boston Scientific, Coloplast Porgés, Cook Medical, Lumenis, Storz; Dr. Cracco: none.

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Scoffone, C.M., Cracco, C.M. The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World J Urol 34, 1175–1181 (2016). https://doi.org/10.1007/s00345-015-1741-y

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  • DOI: https://doi.org/10.1007/s00345-015-1741-y

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