Greenlight XPS - Step 2

This video shows a greenlight XPS prostate surgery for the treatment of male BPH performed by Dr. Kevin Zorn.

In step 2, use of 120W power is used to systematically create deep and wide groves from the bladder neck to the verumontanum. Similar to how one would envision performing a TUIP or to those with HOLEP experience, the GREENLIGHT XPS fibre can be used to create similar throughs though the BPH adenoma down to the surgical capsule. For the remainder of the case, these landmarks are the centre point reference to determine location and extent of dissection. Risk of capsular perforation is markedly reduced when for the remainder of the surgery, the laser is pointed tangential to the capsule. Creation of the 5' and 7' o'clock groves allow the surgeon to then treat an established column of tissue from the lateral sides. As such, all 180W power is fired parallel and away from the surgical capsule. This leads to:

1) a more comfortable surgeon who can visually judge tissue distance
2) less tissue damage beyond the capsule - therefore less patient dysuria
3) more cleaner surgical floor. unlike the previous HPS system and other diode laser systems, a lot of necrotic tissue is left along the surgical bed. While this leads to good hemostasis, patients would suffer with longer healing times (longer dysuria) since the urothelium took longer to heal over. As such, as with all human wounds, epithelialization can only occur after all necrotic tissue has been removed. In my experience, side firing at the adenoma (compared to end on fire centripetally) allows us surgeons to create better wounds.
4) improves efficiency of the surgeon and better durability of the fibre. The surgeon is more comfortable at all times to understand positioning and can safely use the 180W setting. Many surgeons I meet and train fear using the high power. However, in the thought that they will cause less tissue damage, the repetitive passing of laser over the same tissue only coagulates tissue deeper. Moreover, keeping the fibre in the grooves allows better waterflow and less tissue contact. Additionally, in cases of larger prostates or tissue which are dense, the surgeon can also incise larger pieces into smaller fragments and push into the bladder.

In summary, this video highlights the key aspects of "CREATING 5' + 7" O'CLOCK GROVES TO CAPSULE".