Comparison of Modified Single Incision Two Loop Technique and Classical Three Lobe Technique in HoLEP: Experience of 200 Cases of a Single Surgeon

Yıl 2023, , 508 - 511, 31.12.2023

Güçlü Gürlen , Kadir Karkin , Umut Ünal , Bugra Aksay , Mubariz Aydamirov , Ediz Vuruşkan

https://doi.org/10.36516/jocass.1401431

Öz

Introduction: We aimed to present our single incision two-lobe technique, which we developed in our own clinic and performed by a single surgeon and to compare the results of this technique with the results of Gilling's 3-lobe technique, which we applied before.
Material Method: HOLEP was performed in 200 patients with medically resistant lower urinary tract symptoms (LUTS) and BPH, regardless of prostate size, between December 2018 and August 2022 in our urology clinic. All operations in the study were performed by a single surgeon who had completed the HoLEP learning curve, was well versed in endoscopic surgery, and had high experience. The classical Gilling 3-lobe method was preferred in the first hundred cases after the cases in the first fifty cases learning curve (Group 1, n=100). Due to some difficulties in the technique after the experience in the first hundred cases, the single incision two-lobe technique, which was created by referencing and modifying Scoffone's en bloc no touch technique, was used in the next hundred cases (Group 2, n=100).
Results: The average age of a total of 54 patients who underwent surgery due to a retroperitoneal mass was 53.8±10.0 years. While 15 (27.8%) of 54 patients with a retroperitoneal mass were diagnosed incidentally, 39 (72.2%) patients were diagnosed symptomatically. The final pathological outcome of all relapsed patients was liposarcoma. The average operation time was 178.7±85.4 minutes. The average length of stay of the patients was 6.2±3.1 days. Additionally, all of these patients had organ resection. In the Kaplan-Meier survival analysis, it was found that surgical margin had a statistically significant effect on average survival (p<0.001).
Conclusion: In our modified single-incision two-lobe technique, the eneculation time and probe residence time are shorter than the classical gilling method.

Anahtar Kelimeler

HOLEP, Gilling, the single incision two-lobe technique

Kaynakça

• 1. Fraundorfer MR and Gilling PJ. Holmium: YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. European urology. 1998; 33(1):69-72.
• 2. Cornu JN, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. European urology. 2015; 67(6):1066-1096.
• 3. Lee S, Choi W, Lee JB, et al. Transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement: a quality and meta-analysis. International neurourology journal. 2013; 17(2): 59.
• 4. Fraundorfer MR, Gilling PJ, Kennett KM, et al. Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study. Urology. 2001; 57(3):454-458.
• 5. Elzayat EA and Elhilali MM. Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. European urology. 2007; 52(5):1465-1472.
• 6. Reich O, Gratzke C, Stief CG. Techniques and long-term results of surgical procedures for BPH. European urology. 2006; 49(6):970-978.
• 7. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. European urology. 2008; 53(1):160-168.
• 8. Moody JA and Lingeman JE. Holmium laser enucleation for prostate adenoma larger than 100 gm: comparison with open prostatectomy. J Urol. 2001; 165:459-62.
• 9. Tan AH and Gilling PJ. Holmium laser prostatectomy: current techniques. Urology. 60(1):152-156.
• 10. Elmansy HM, Kotb A, Elhilali MM. Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate?. The Journal of urology. 2011; 186(5):1977-1981.
• 11. Cho K, Koh J, Choi JS, et al. Factors associated with early recovery of stress urinary incontinence following holmium laser enucleation of the prostate in patients with benign prostatic enlargement. International Neurourology Journal. 2018; 22(3): 200.
• 12. Porpiglia F, Terrone C, Renard J, et al. Transcapsular adenomectomy (Millin): a comparative study, extraperitoneal laparoscopy versus open surgery. European urology. 2006; 49(1):120-126.
• 13. Sotelo R, Clavijo R, Carmona O, et al. Robotic simple prostatectomy. The Journal of urology.2008; 179(2):513-515.
• 14. Gilling PJ and Fraundorfer MR. Holmium laser prostatectomy: a technique in evolution. Current opinion in urology. 1998; 8(1):11-15.
• 15. Kelly DC and Das A. HOW I DO IT-Holmium laser enucleation of the prostate technique for benign prostatic hyperplasia. Canadian Journal of Urology. 2012; 19(1):6131.
• 16. Scoffone CM and Cracco CM. The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World journal of urology. 2016; 34:1175-1181.
• 17. Kuntz RM. Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). European urology. 2006; 49(6):961-969 . 18. Anderson BB, Heiman J, Large T, et al. Trends and perioperative outcomes across major benign prostatic hyperplasia procedures from the ACS-NSQIP 2011–2015. Journal of endourology. 2019; 33(1):62-68.
• 19. Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. The Journal of urology. 2010;183(3):1105-1109.
• 20. Kuntz RM, Ahyai S, Lehrich K, et al. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. The Journal of urology. 2004; 172(3):1012-1016.
• 21. Saitta G, Becerra JEA, Del Álamo JF, et al. ‘En Bloc’HoLEP with early apical release in men with benign prostatic hyperplasia. World journal of urology. 2019; 37:2451-2458.
• 22. Miernik A and Schoeb DS. “Three horse shoe-like incision” holmium laser enucleation of the prostate: first experience with a novel en bloc technique for anatomic transurethral prostatectomy. World Journal of Urology. 2019; 37:523-528.
• 23. Suh J, Choo MS, Oh SJ. Efficacy and safety of low power holmium laser enucleation of the prostate: A prospective short-and medium-term single-blind randomized trial. Investigative and Clinical Urology. 2023; 64(5):480.
• 24. Kim M, Lee HE, Oh SJ. Technical aspects of holmium laser enucleation of the prostate for benign prostatic hyperplasia. Korean journal of urology. 2013; 54(9):570-579.
• 25. Gong YG, He DL, Wang MZ, et al. Holmium laser enucleation of the prostate: a modified enucleation technique and initial results. The Journal of urology. 2012;187(4):1336-1340.
• 26. Shigemura,K, Yamamichi F, Kitagawa K, et al. Does surgeon experience affect operative time, adverse events and continence outcomes in holmium laser enucleation of the prostate? A review of more than 1,000 cases. The Journal of Urology. 2017; 198(3):663-670.
• 27. Endo F, Shiga Y, Minagawa S, et al. Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence. Urology. 2010; 76(6):1451-1455.
• 28. Tokatli Z, Esen B, Yaman Ö, et al. Comparison of 3 Different Enucleation Techniques of Holmium Laser Enucleation of Prostate (HoLEP). Urology Journal. 2020;17(4).