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En Bloc Thulium Laser Enucleation of the Prostate: A Step-by-Step Guide to Improve Enucleation Time and Efficiency for Endoscopic Enucleation of Prostatic Adenoma
Accepted Manuscript
En Bloc Thulium Laser Enucleation of the Prostate: a step-by-step guide to improve enucleation time and efficiency for endoscopic enucleation of prostatic adenoma A. Pacchetti , Giacomo Maria Pirola , Lorenzo Berti , Mara Palumbo , Giuseppe Ietto , Giulio Carcano , Carlo Terrone , S. Giovanniaredi PII: DOI: Reference:
S0090-4295(18)31197-X https://doi.org/10.1016/j.urology.2018.11.006 URL 21327
To appear in:
Urology
Please cite this article as: A. Pacchetti , Giacomo Maria Pirola , Lorenzo Berti , Mara Palumbo , Giuseppe Ietto , Giulio Carcano , Carlo Terrone , S. Giovanniaredi , En Bloc Thulium Laser Enucleation of the Prostate: a step-by-step guide to improve enucleation time and efficiency for endoscopic enucleation of prostatic adenoma, Urology (2018), doi: https://doi.org/10.1016/j.urology.2018.11.006
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT TITLE PAGE
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VIDEO ARTICLE TITLE: En Bloc Thulium Laser Enucleation of the Prostate: a step-bystep guide to improve enucleation time and efficiency for endoscopic enucleation of prostatic adenoma AUTHORS’ NAMES: Pacchetti A1, Pirola GM2, Berti L3, Palumbo M4, Ietto G4, Carcano G4, Terrone C1 and Saredi G3 AFFILIATION: 1 Department of Urology, University of Genoa, Genoa, Italy. 2 Department of Urology, San Donato Hospital, Arezzo. 3 Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. 4 Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. CORRESPONDING AUTHOR: Andrea Pacchetti. Addresses: Department of Urology, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132 Genoa, Italy. Phone: +393383409342. Fax: +390105556328. email: [email protected] OTHER AUTHORS: Giacomo Maria Pirola, Department of Urology, San Donato Hospital, Arezzo. e-mail: [email protected]
ED
Lorenzo Berti, Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. e-mail: [email protected]
CE
PT
Mara Palumbo, Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. e-mail: [email protected]
AC
Giuseppe Ietto, Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. e-mail: [email protected] Giulio Carcano, Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. e-mail: [email protected] Carlo Terrone, Department of Urology, University of Genoa, Genoa, Italy. e-mail: [email protected] Giovanni Saredi, Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. 1
ACCEPTED MANUSCRIPT
ABSTRACT
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e-mail: [email protected] ABSTRACT WORD COUNT: 292 KEY WORDS: benign prostatic hyperplasia; thulium laser; thulium laser enucleation of the prostate; endoscopic enucleation of the prostate. ACKNOWLEDGEMENTS: none CONFLICT OF INTEREST: none FINANCIAL DISCLOSURE: The authors declare that they have no relevant financial interest
Objective To present a reproducible step by step approach to En-Bloc Thulium Laser Enucleation of the Prostate (ThuLEP) for benign prostatic hyperplasia surgical treatment. Laser adenoma
AN US
enucleation is nowadays a recognized surgical treatment for benign prostatic enlargement. Some variants to the classical 3-lobes laser techique have been proposed, in order to overcome the main concerns regarding the original procedure1, 2, 3, 4. After a vast experience with the 3-lobes ThuLEP, we developed our own en-bloc enucleation
M
technique.
Methods The capsular plane is identified only once, at the level of the prostatic apex, at 5 o’clock;
ED
this plane is followed ascending towards the bladder neck, separating the left lobe from the prostatic capsule from 5 to 11 o’clock. The right and median lobes are then enucleated
PT
following the same plane clockwise and the two planes are joined anteriorly at 11 o’clock. Finally, enucleation is completed by incising the remaining mucosal flap from 10 to 2
CE
o’clock. We have already proved the clear advantages provided by this technique compared to the “three-lobes” enucleation5.
AC
Results Our single-center experience with this technique includes 140 procedures performed up to June 2018. Mean prostatic adenoma volume was 66.7 mL (range 20-220 ± 32.85 standard deviation (SD)). Mean total surgical time was 60.93 min (25-133 ± 23.6 SD); mean enucleation time was 18.3 minutes (8.2-36.53 ± 5.62 SD), mean enucleation time normalized per adenoma gram was 0.32 min/g (0.12-0.8 ± 0.15 SD) and mean energy needed for the enucleation normalized per adenoma gram was 1852.13 J/g (689-6129 ±862.4 SD). Only one case of reintervention for clot evacuation (Clavien grade IIIb) was necessary. 2
ACCEPTED MANUSCRIPT Conclusion En Bloc ThuLEP provides an anatomical approach for endoscopic enucleation of prostatic adenoma. We believe that this sequence optimizes efficiency and efficacy in a reproducible way. References 1. Scoffone CM, Cracco CM. The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World J Urol. 2016;34:1175-1181.
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2. Dellabella M, Castellani D. Anatomical Control of Adenoma Technique: An Accurate Surgical Approach to Thulium Laser Enucleation of the Prostate. Urology. 2018 Mar; 113:252.
3. Castellani D, Saredi G, Pirola GM, Gasparri L, Pavia MP, Ambrosini F, Berti L, Sembenini F, Dellabella M. Comparison between two different en bloc Thulium
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laser enucleation of the prostate: does technique influence complications and outcomes?. Urology. 2018 Jun 10. pii: S0090-4295(18)30544-2. 4. Misrai V, Kerever S, Phe V, Zorn KC, Peyronnet B, Rouprêt M. Direct Comparison of GreenLight Laser XPS Photoselective Prostate Vaporization and GreenLight Laser En Bloc Enucleation of the Prostate in Enlarged Glands Greater than 80 ml: a
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Study of 120 Patients. J Urol. 2016 Apr;195(4 Pt 1):1027-32. 5. Saredi G, Pacchetti A, Pirola GM, Berti L, Ambrosini F, Martorana E, Marconi AM.
ED
En Bloc Thulium Laser Enucleation of the Prostate: Surgical Technique and
AC
CE
211.
PT
Advantages Compared With the Classical Technique. Urology. 2017 Oct; 108:207-
3
En Bloc Thulium Laser Enucleation of the Prostate: a step-by-step guide to improve enucleation time and efficiency for endoscopic enucleation of prostatic adenoma A. Pacchetti , Giacomo Maria Pirola , Lorenzo Berti , Mara Palumbo , Giuseppe Ietto , Giulio Carcano , Carlo Terrone , S. Giovanniaredi PII: DOI: Reference:
S0090-4295(18)31197-X https://doi.org/10.1016/j.urology.2018.11.006 URL 21327
To appear in:
Urology
Please cite this article as: A. Pacchetti , Giacomo Maria Pirola , Lorenzo Berti , Mara Palumbo , Giuseppe Ietto , Giulio Carcano , Carlo Terrone , S. Giovanniaredi , En Bloc Thulium Laser Enucleation of the Prostate: a step-by-step guide to improve enucleation time and efficiency for endoscopic enucleation of prostatic adenoma, Urology (2018), doi: https://doi.org/10.1016/j.urology.2018.11.006
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT TITLE PAGE
M
AN US
CR IP T
VIDEO ARTICLE TITLE: En Bloc Thulium Laser Enucleation of the Prostate: a step-bystep guide to improve enucleation time and efficiency for endoscopic enucleation of prostatic adenoma AUTHORS’ NAMES: Pacchetti A1, Pirola GM2, Berti L3, Palumbo M4, Ietto G4, Carcano G4, Terrone C1 and Saredi G3 AFFILIATION: 1 Department of Urology, University of Genoa, Genoa, Italy. 2 Department of Urology, San Donato Hospital, Arezzo. 3 Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. 4 Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. CORRESPONDING AUTHOR: Andrea Pacchetti. Addresses: Department of Urology, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132 Genoa, Italy. Phone: +393383409342. Fax: +390105556328. email: [email protected] OTHER AUTHORS: Giacomo Maria Pirola, Department of Urology, San Donato Hospital, Arezzo. e-mail: [email protected]
ED
Lorenzo Berti, Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. e-mail: [email protected]
CE
PT
Mara Palumbo, Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. e-mail: [email protected]
AC
Giuseppe Ietto, Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. e-mail: [email protected] Giulio Carcano, Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. e-mail: [email protected] Carlo Terrone, Department of Urology, University of Genoa, Genoa, Italy. e-mail: [email protected] Giovanni Saredi, Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. 1
ACCEPTED MANUSCRIPT
ABSTRACT
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e-mail: [email protected] ABSTRACT WORD COUNT: 292 KEY WORDS: benign prostatic hyperplasia; thulium laser; thulium laser enucleation of the prostate; endoscopic enucleation of the prostate. ACKNOWLEDGEMENTS: none CONFLICT OF INTEREST: none FINANCIAL DISCLOSURE: The authors declare that they have no relevant financial interest
Objective To present a reproducible step by step approach to En-Bloc Thulium Laser Enucleation of the Prostate (ThuLEP) for benign prostatic hyperplasia surgical treatment. Laser adenoma
AN US
enucleation is nowadays a recognized surgical treatment for benign prostatic enlargement. Some variants to the classical 3-lobes laser techique have been proposed, in order to overcome the main concerns regarding the original procedure1, 2, 3, 4. After a vast experience with the 3-lobes ThuLEP, we developed our own en-bloc enucleation
M
technique.
Methods The capsular plane is identified only once, at the level of the prostatic apex, at 5 o’clock;
ED
this plane is followed ascending towards the bladder neck, separating the left lobe from the prostatic capsule from 5 to 11 o’clock. The right and median lobes are then enucleated
PT
following the same plane clockwise and the two planes are joined anteriorly at 11 o’clock. Finally, enucleation is completed by incising the remaining mucosal flap from 10 to 2
CE
o’clock. We have already proved the clear advantages provided by this technique compared to the “three-lobes” enucleation5.
AC
Results Our single-center experience with this technique includes 140 procedures performed up to June 2018. Mean prostatic adenoma volume was 66.7 mL (range 20-220 ± 32.85 standard deviation (SD)). Mean total surgical time was 60.93 min (25-133 ± 23.6 SD); mean enucleation time was 18.3 minutes (8.2-36.53 ± 5.62 SD), mean enucleation time normalized per adenoma gram was 0.32 min/g (0.12-0.8 ± 0.15 SD) and mean energy needed for the enucleation normalized per adenoma gram was 1852.13 J/g (689-6129 ±862.4 SD). Only one case of reintervention for clot evacuation (Clavien grade IIIb) was necessary. 2
ACCEPTED MANUSCRIPT Conclusion En Bloc ThuLEP provides an anatomical approach for endoscopic enucleation of prostatic adenoma. We believe that this sequence optimizes efficiency and efficacy in a reproducible way. References 1. Scoffone CM, Cracco CM. The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World J Urol. 2016;34:1175-1181.
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2. Dellabella M, Castellani D. Anatomical Control of Adenoma Technique: An Accurate Surgical Approach to Thulium Laser Enucleation of the Prostate. Urology. 2018 Mar; 113:252.
3. Castellani D, Saredi G, Pirola GM, Gasparri L, Pavia MP, Ambrosini F, Berti L, Sembenini F, Dellabella M. Comparison between two different en bloc Thulium
AN US
laser enucleation of the prostate: does technique influence complications and outcomes?. Urology. 2018 Jun 10. pii: S0090-4295(18)30544-2. 4. Misrai V, Kerever S, Phe V, Zorn KC, Peyronnet B, Rouprêt M. Direct Comparison of GreenLight Laser XPS Photoselective Prostate Vaporization and GreenLight Laser En Bloc Enucleation of the Prostate in Enlarged Glands Greater than 80 ml: a
M
Study of 120 Patients. J Urol. 2016 Apr;195(4 Pt 1):1027-32. 5. Saredi G, Pacchetti A, Pirola GM, Berti L, Ambrosini F, Martorana E, Marconi AM.
ED
En Bloc Thulium Laser Enucleation of the Prostate: Surgical Technique and
AC
CE
211.
PT
Advantages Compared With the Classical Technique. Urology. 2017 Oct; 108:207-
3