En bloc greenlight laser enucleation of prostate (GreenLEP): about the first hundred cases

Panthier, F.; Pasquier, Jennifer; Bruel, Sébastien; Azancot, Vidal; Taille, Alexandre de la; Gasman, D.

doi:10.1007/s00345-019-02941-1

Cited by 12 publications

(8 citation statements)

References 18 publications

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“…While several studies have previously evaluated the learning curve for holmium laser enucleation of the prostate (HoLEP) (30), only few experiences have been published so far on PVP (17-21, 30, 31). In this scenario, our study confirms the opportunity to achieve favorable outcomes even by less experienced surgeons (19), if appropriately mentored through a structured step-by-step program.…”

Section: Discussionsupporting

confidence: 71%

“…In fact, our program allowed the surgeon in training to achieve proficiency while ensuring optimal patient outcomes. Importantly, while previous studies evaluating the learning curve of Greenlight vaporization/enucleation of the prostate relied on stronger endpoints such as surgical complications to benchmark surgical performance (17)(18)(19)(20)(21), we could not use such outcomes in our study due to the relatively low sample size and low number of events. As such, we relied on the amount of energy delivered on the prostate as a potential surrogate of the efficacy of surgery, being associated with the risk of persistent LUTS in the postoperative period (25,26).…”

Section: Discussionmentioning

confidence: 99%

“…Despite GreenLight laser photovaporization (PVP) having been standardized and described at all levels, from standard PVP to more complex procedures involving enucleation (13,14), there is a lack of studies evaluating how to safely train novice surgeons with prior endoscopic experience in PVP using robust and standardized metrics. Moreover, while several studies aimed at evaluating the safety and efficacy of PVP focused the analysis on the number of procedures required in order to achieve proficiency (15)(16)(17), data are limited by the heterogeneous criteria used to assess the learning curve (18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

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Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience

Sessa

Campi

Granieri³

et al. 2021

Front. Surg.

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Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate.Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate.Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times.Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience

Sessa

Campi

Granieri³

et al. 2021

Front. Surg.

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“…Transurethral anatomical enucleation of the prostate with Greenlight laser was firstly described by Gomez Sancha et al in 2015 [5]. Panthier et al 2019 [42] published the first short-term perioperative outcomes in 100 patients treated with Greenlight enucleation of the prostate (GreenLEP) underlying a significant improvement of IPSS, QoL, and Qmax at 1, 6, and 12 months postoperatively, similar to the previous big HoLEP series and conventional TURP. At the end of the follow up period, PVR was reduced, compared to preoperative characteristics (318 ± 267 mL to 95 ± 62 mL), while PSA decreased from a mean of 6.17 ng/mL to 1.06 ng/mL, and prostate volume from 85.8 mL to 24 mL, respectively.…”

Section: Body Of Evidencementioning

confidence: 57%

Lasers in Transurethral Enucleation of the Prostate—Do We Really Need Them

Herrmann

Gravas²,

Rosette

et al. 2020

JCM

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The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.

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“…In stone surgery, RE has been gaining attention, based on the same design than in benign prostatic obstruction laser procedures: Holmium and Greenlight Laser Enucleation of the Prostate (HoLEP and GreenLEP) has adopted the delivered energy as an effectiveness criteria, even more during the learning curve [19,20]. Consequently, the evaluation of an endoscopic stone procedure and surgeons may rely on the delivered energy for a stone volume.…”

Section: Required Energy To Treat 1 MM 3 Of Stonementioning

confidence: 99%

How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

et al. 2020

Self Cite

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Introduction Holmium:yttrium-aluminium-garnet (Ho:YAG) is currently the gold standard for lithotripsy for the treatment of all known urinary stone types. Stone composition and volume are major determinants of the lithotripsy. This in vitro study evaluated the required energy to ablate 1 mm 3 of various stone types with different laser settings using Ho:YAG. Methods 272 µm core-diameter laser fibers (Boston Scientific © ) were connected to a 30 Watt MH1 Ho:YAG generator (Rocamed®). An experimental setup consisting of immerged human stones of calcium oxalate monohydrate (COM), uric acid (UA) or cystine (Cys) was used with a single pulse lasing emission (0.6/0.8/1 J), in contact mode. Stones were dried out before three-dimensional scanning to measure ablation volume per pulse (AVP) and required energy to treat 1 mm 3 (RE). Results All settings considered, ablation volumes per pulse (AVP) for COM were significantly lower than those for UA and Cys (p = 0.002 and p = 0.03, respectively), whereas AVP for Cys was significantly lower than those for UA (p = 0.03). The mean REs at 0.6 J pulse energy (PE) for COM, Cys and UA were 34, 8.5 and 3.2 J, respectively The mean REs at 1 J PE for COM, Cys and UA were 14.7, 6.4 and 2 J, respectively. At 0.6 J PE, RE for COM was more than tenfold and fivefold higher than those for UA and Cys, respectively. Conclusion This in vitro study shows for the first time a volumetric evaluation of Ho:YAG efficiency by the ablation volume per pulse on human stone samples, according to various pulse energies. The REs for COM, UA and Cys should be considered in clinical practice.

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En bloc greenlight laser enucleation of prostate (GreenLEP): about the first hundred cases

Cited by 12 publications

References 18 publications

Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience

Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience

Lasers in Transurethral Enucleation of the Prostate—Do We Really Need Them

How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

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