Presentation Authors: Yasser Hussein Mohamed Ismail*, Stefano Corti, Francesca Ceresoli, Raffaella Milesi, Ivano Vavassori, Treviglio, Italy
Introduction: The endoscopic technique of enucleation of the prostatic adenoma with Holmium laser (HoLEP) was introduced in 1998 by Peter Gilling. The enucleation technique and holmium laser production technology has remained almost unchanged for 20 years.After years of research, Lumenis has developed a system capable of modify the production of the Holmium laser pulse with the Moses technology in order to optimize the laser to lithotripsy and enucleation of the prostate.In the video we show how Moses technology can improve HoLEP execution.
Methods: The Moses technology allows to modify the shape of the laser pulse and therefore of the plasma bubble produced by the interaction between Holmium laser and water.The laser energy in HoLEP is used in two different ways, one is vaporization of prostate tissue making the incisions prior to the enucleation; the second mode exploits the mechanical effect called "photoacoustic effect", due to the expansion of the plasma bubble, resulting in a pressure wave that propagates to promote cleavage of tissues in course of detachment of the adenoma from the capsule during enucleation.
Results: As shown the application of Moses technology during HoLEP allows a better interaction between laser and prostatic tissue; during incisions the MoSES is able to produce a vaporization of greater depth, therefore more effective, during anterograde incision; the oblong plasma bubble allows the tissue flaps to be kept out of the way, while proceeding retrograde, allowing the capsular plane already exposed to be kept under visual control, optimizing the course and duration of the incisions.The photoacoustic effect produced with Moses technology allows obtaining a longer detachment of the tissues with respect to the conventionally produced impulse, resulting in a greater efficiency in enucleation due to the separation of longer tissue segments and for better exposure of the plan.
Conclusions: The Moses technology makes the HoLEP more effective when performed by an expert operator due to reduction of incision and enucleation times and is able to simplify the learning curve for beginners given due to the better development and exposure of enucleation plans.