This document discusses tools and techniques for holmium laser enucleation of the prostate (HoLEP). It provides tips for different laser settings for cutting and coagulation. It emphasizes the importance of hemostasis during morcellation and describes techniques for handling the prostate in lobes or en bloc. Potential complications like transient stress urinary incontinence are addressed. Experience levels for surgeons of different prostate sizes are noted, and the value of mentorship programs is highlighted.

1. Prof Chui Ka Lun
Hong Kong private urologist
FRCS Edin(Uro) FHKAM
Hon Assistant Prof The Chinese
University of Hong Kong

2. Tools
Lumenis P100
Karl Storz 26Fr Laser Scope
Karl Storz Uromat EASI irrigation system
Karl Storz Drill Cut morcellator

3. Tools
Lumenis P100
Karl Storz 26Fr Laser Scope with
working element
Karl Storz Uromat EASI irrigation system
Karl Storz Drill Cut morcellator

4. Tools
Lumenis P100
Karl Storz 26Fr Laser Scope
Karl Storz Uromat EASI irrigation system
Karl Storz Drill Cut morcellator
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5. Tools
Lumenis P100
Karl Storz 26Fr Laser Scope
Karl Storz Uromat EASI irrigation system
Karl Storz Drill Cut morcellator
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6. Two Pedals are always better than one
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7. Pulse width function
Short pulse
2.0J x 45 Hz
● Cutting hardly
● Enucleation
● Plane exploration
● Adenoma
Long pulse
1.8J x 40Hz
● Cutting gently
● Coagulation
● Mucosa
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8. Enucleation is Enculeation is ….BUT the essential is
Holmium is still the best as still
Not depends on blunt dissection by scope
manipulation
as
Shock Waves will find the path for you
and
Bladder stones fragmented in same session
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9. 9

10. Tips and Tricks
Immediate / Pre emptive coagulation better
than control bleeding
Stay close to adenoma
Beware Mid gland 3 & 9 oclock, Bladder
neck 2 and 10 oclock , unnamed penetrating
vessels
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“ significant bleeders were the 2-
5 and 7-10 o'clock positions in
the proximal prostate.”
Prof Oh et al.

11. Morcellation Safety
Haemostasis is the key to
morcellation success
Trust your hand, palpate bladder
Facing morcellator downward
Oscillating better VersaCut
Keep 900-1000 bpm rate (Karl storz Drillcut)
Slow is better than Fast
“ significant bleeders were the 2-
5 and 7-10 o'clock positions in
the proximal prostate.”
Prof Oh et al.

12. enbloc or 2 lobe or 3 lobe
Surgeon preference
start with 3 lobe then enbloc IMHO
Midlobe channel opening for better irrigation
Less struggling under the “balls”
Uvula concept
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13. Typical Uvula day If Atypical Uvula….
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14. Transient Stress Urinary Incontinence (TSUI)
Mucosa-sphincter complex flap
Preserve apical mucosal flap extending
cranially with sphicter muscle fibres
don’t be obsess to enucleate ant lobe
feel comfortable to follow short wave opening
path
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15. THANK YOU

16. Prostate size, step by step
Beginner: 40-60gm
30 cases learning curve
Intermediate: 60-100gm
50 cases
Senior: Redo / >100gm
Mentorship program is IMPORTANT
Watching online videos repeatedly is useful
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