Holmium: YAG laser prostatectomy canine feasibility study.

Abstract

Laser coagulation prostatectomy performed with the Neodymium: Yttrium-Aluminum-Garnet laser has emerged as a viable alternative for the treatment of benign prostatic hyperplasia. Laser vaporization prostatectomy, if feasible, has the potential to reduce postoperative catheterization time and achievement time of maximum voiding outcomes. The objective of this study was to determine the ability of the Holmium: Yttrium-Aluminum-Garnet laser wavelength to vaporize prostatic tissue and create an immediate prostatectomy defect. The Holmium: Yttrium-Aluminum-Garnet laser was applied in vivo in a canine prostate model. Laser energy was delivered endoscopically via quartz laser fibers circumferentially to each prostatic fossa. High energies, up to 2.8 joules per pulse and 60 watts total power, were utilized. All prostates were surgically removed immediately following laser applications to determine acute laser effects. Immediate tissue ablation or vaporization with this laser wavelength was found to be both feasible and relatively efficient. The mean transverse dimension of the prostatic defects produced was 19 mm, with a maximum transverse dimension of 27 mm. In one prostate a cavity of 27 (transverse) by 29 (anterior-posterior) by 43 (length) mm was created, with an estimated tissue removal of approximately 20 cc. Hemostasis with the Holmium laser was adequate in this canine prostate model. In addition to the acute tissue cavity created, a 1-2 mm rim of surrounding tissue coagulation was observed in each specimen. The Holmium: Yttrium-Aluminum-Garnet laser wavelength is capable of acute prostatic tissue vaporization and deserves ongoing study with potential application in the surgical treatment of benign prostatic hyperplasia in men.