Introduction: The reaction of prostate tissue to holmium laser during Holmium laser Enucleation of Prostate (HoLEP) can be largely divided into incision, hemostasis, and vibration. Recently, high-power devices have been introduced. Therefore, the authors attempted to characterize tissue response by laser power in HoLEP using a 120-watt device.
Methods: Using a 120-watt equipment (MOSES Pulse 120H, Lumenis), each laser pulse width (short/ medium/ long pulse, ), mode (MOSES, non-MOSES), pulse energy (Joule), repetition rate (HoLEP surgery was performed by dividing by Hz) and by power (watt). HoLEP surgery was performed using an early inverted V-shaped mucosal incision method based on the traditional 3-lobe technique by a single operator (sjo). The surgical videos were qualitatively evaluated by two other HoLEP surgery experts (msc, sjj) on the effect of each laser on the tissue response.
Results: During incision, tissue charring was more prominent in the long-pulse mode than in the short-pulse mode. The long-pulse mode was very effective for hemostasis, but the vibration effect was the least. Therefore, it was safe to apply the original settings without adjusting J or Hz during hemostasis in prostatic fossa after enucleation. The short-pulse mode is still the best for vibration: the higher the Hz, the stronger the vibration effect. However, the short-pulse mode was less effective for hemostasis as in the past 100-watt equipment. When the power was increased to 120 watts in all four output modes, the efficiency of each tissue reaction was increased. However, at a power setting above 100 watts, unintentional incisions and poor visibility were caused. Tissue response to MOSES mode was close to that of the medium pulse and its advantage was not remarkable during HoLEP.
Conclusions: Our results showed that the prostatic tissue responses to laser pulse width were distinct. Setting the modes according to the characteristics of each laser pulse mode will be helpful for surgical efficiency.
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