Laser applications in BPH therapy
Laser treatment of the prostate continues to be an exceptionally popular method of treatment with surgeons. This intervention is being increasingly used for therapy of BPH (benign prostate hyperplasia). Key benefits, such as minimum loss of blood, improved coagulation properties, shorter stays in hospital, and reduced learning curve for mastering the technique are some of the factors that have resulted in the rising trend for use of this method of treatment.
The advent of the GreenLight PV (80 watt) and HPS (120 watt) systems, with a 532 nm wavelength providing excellent ablative and hemostatic properties, has made laser treatment of BPU much more universal and it has been widely adopted across the world. GreenLight laser vaporization of the prostate has become a standard treatment in many hospitals and permits the treatment of high-risk patients including those on anticoagulation therapy, with minimum risk and short periods of hospitalization.
However, one disadvantage has revealed that this therapy tends to be more suitable for smaller prostate adenomas. The treatment of large adenomas has proved to be extremely time-consuming and cost-intensive. Another negative aspect has been the lack of tissue available for histological examination after vaporization has taken place.
The GreenLEP Set from Richard Wolf now also permits enucleation with the GreenLight Laser which previously only vaporized prostate tissue. However, contrary to the previous vaporization technique using the GreenLight Laser, tissue chips can now be retained for histological investigation.
"GreenLEP" or GreenLight enucleation of the prostate allows complete enucleation of adenomatous tissue with power of only 80 watts. It uses the outstanding hemostatic effect of the GreenLight Laser. This makes the subsequent morcellation an exceptionally safe procedure which can be carried out under ideal conditions for visualization. The primary objective is to stop bleeding during the enucleation process so that the irrigation fluid is kept crystal clear while the procedure is being carried out.
This laser allows urological surgeons to start their initial cases performing vaporization and when sufficient experience has been gained, to progress to enucleation – starting with medium-sized prostates.
Four different, complete GreenLEP instrument sets can be supplied for BPH therapy. Only the application of optimized instruments allows the full benefits of this laser technology to be achieved and surgical results to be improved.
"Freestyle" working insert for GreenLight laser fibers
- The GreenLight "Freestyle" working insert guarantees perfect freedom of movement for users
- Users can maneuver in an axial and radial direction without any restriction
Laser resectoscope – the perfect alternative to the "Freestyle" Laser instrument
- Passive working element
- Laser fiber guide with spring element for avoiding vibrations at the distal probe tip
- Defined length stop for laser probe
PIRANHA Laser Enucleation System
Laser enucleation for BPH is continually increasing in importance. Richard Wolf markets its own tissue morcellator for shredding the prostate tissue produced during the process of enucleation. The PIRANHA Laser Enucleation System offers urologists a comprehensive, precisely coordinated system comprising laser resectoscope, PIRANHA Scope and tissue morcellator. The exceptionally powerful, safe and easily operated PIRANHA tissue morcellator simplifies the GreenLEP technique and expedites the intervention.
- Enucleation and morcellation without changing sheath
- Enucleation and morcellation is even possible with 24.5 Fr. continuous irrigation
- Can be used with all laser fibers up to 1000 μm
- Precise enucleation with special fiber guidance
- Intuitive operation of instruments and devices
- This system can also be used with resectoscope working elements for hemostasis or for secondary resection
Special laser resectoscope sheath for blunt enucleation of the prostate
- Optional special sheath for laser TUR-P
- Inner sheath with thickened stainless steel tip: Particularly resistant and robust, even if the laser is inadvertently triggered
- One working element for all laser fibers
- Biggest selection of guide tubes
- Working element can be used with the same sheath as the PIRANHA Scope. This eliminates the need to change the sheath!
- Also possible to work with rotatable 24.5 Fr. continuous irrigation sheath
- If necessary, the laser working element can be exchanged for a resectoscope working element (monopolar or bipolar) in order to carry out subsequent resection or coagulation
- Outstanding visualization conditions through integrated irrigation channels
- Can be used without changing sheath – enucleation and morcellation with one sheath
- Rotatable adapter allows it to fit in the outer sheath of a continuous irrigation sheath
- Large working channel of 5 mm also accommodates a morcellator alongside high irrigation performance
- Telescope can be used with rotatable irrigation sheaths of 24.5 or 26 Fr.