Videosurgery
Top-down thulium fiber laser enucleation of the prostate: technical aspects
Hazem Elmansy, Waleed Shabana, Miranda Waugh, Abdulrahman Ahmad, Ruba Abdul Hadi, Walid Shahrour
Citation: Elmansy H, Shabana W, Waugh M, et al. Top-down thulium fiber laser enucleation of the prostate: technical aspects. www.ceju.online/journal/2021/thulium-fiber-laser-prostate-enucleation-topdown-soltive--ThuFLEP-2129.php
Key Words: thulium fiber laser • prostate enucleation • top-down • soltive • ThuFLEP

Using 0.6 J/70 Hz, one posterior groove is created at either the 5 or 7 o'clock position up to the verumontanum, allowing simultaneous enucleation of the median lobe, with the attached lateral lobe. The urethral mucosa between the lateral lobe and the verumontanum is incised on both sides to expose the surgical capsule. The resectoscope is rotated upside-down at the 12 o'clock position. The anterior commissure mucosa is then incised starting from the bladder neck at the 12 o'clock position. The dissection plane is created between the adenoma and the surgical capsule anterolaterally using a sequence of short incisions. Once the plane between the adenoma and surgical capsule is created, a top-down lateral lobe dissection is performed and extended anteroposteriorly towards the apical adenoma at the 6 o'clock position. Once the 6 o'clock position is reached, the resectoscope is withdrawn backwards to visualize the mucosal strip. It appears as a band-shaped structure attached to the sphincter on the medial side of the scope. By incising the band-shaped mucosa close to the adenoma, the apex of the adenoma is completely released without damaging the ring formed by the sphincter muscle. Dissection is continued from the bladder neck to the 6 o'clock position. The remaining attachment between the adenoma and surgical capsule is dissected using a combination of lateral and retrograde dissections. Once the surgeon reaches the bladder neck at 6 o'clock the remaining attachment between the adenoma and surgical capsule is separated at the bladder neck from lateral to medial.

Article history
Submitted: 14 January, 2021
Accepted: 26 April, 2021
Published online: 5 May, 2021
doi: 10.5173/ceju.2021.0010.R1
Corresponding author
Hazem Elmansy
email: hazem.mansy@rocketmail.com
Conflicts of interest:  The authors declare no conflicts of interest.
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