Holmium Laser Enucleation of the Prostate, Tips and Tricks Not Just for Beginners

Abstract Holmium laser enucleation of the prostate (HoLEP) is an endoscopic procedure that was first introduced in 1998 by Peter Gilling. Numerous studies have since confirmed that the technique is efficacious with durable outcomes, and many investigators now consider HoLEP the new gold standard. The surgeon searches for the capsular plane by making two incisions at the 5- and 7-o'clock positions beginning at the bladder neck and ending at the verumontanum. It is important at this stage to proceed one layer at a time while opening the bladder neck until the circular fibers of the neck are exposed. The surgeon should then proceed from the neck to the verum, deepening and widening the incision by separating the lateral lobe from the median portion. The surgeon should take care at this stage to push laterally with the whole instrument in the apex region detaching the adenoma from the capsule with the laser turned off, thus creating an apical incision along the cleavage plane causing subsequent detachment of ...