The word laser is the Turkish abbreviation of the term "Light Amplification of Stimulated Emission of Radiation-LASER". The laser was first discovered by the American physicist Theodorev H. Maiman (1960), and its use in urogenital surgery was made by Persons (1966).
Laser types used in urological surgery today:
1-Carbon Dioxide-CO2 Laser,
2-Neodymium:Yttrium-Aluminum-Garnet (Nd: YAG),
3-Holmium:Yttrium-Aluminum-Garnet (Ho:YAG),
4-Potassium-Titanyl-Phosphate (KTP) and Thulium laser.
LASER SURGERY USED AND LASER TYPES USED
HOLEP PROSTATECTOMY: HOLEP : HoLEP refers to prostate surgery performed with Holmium Laser. Holmium laser, its name in scientific technology is Holmium: Yittrium-Aluminum-Garnet (Ho: YAG) laser. Since its wavelength (2120) is close to the upper note of water (1910 nm), it is absorbed very well in tissue and stone breaking and allows effective use. Ho:YAG laser is used for stone breaking with the endoscopic fiber-probe of the device at low watts (20-40Watt), while at high watts (60-120watt) it is used for simultaneous cutting, bleeding control and vaporization, especially in the prostate and other tissues. Because the use of holmium laser in urology first started with lithotripsy.
The most important difference of holmium laser from other lasers is that its destructive/caustic effect on the applied tissue is not very deep, its effect remains relatively superficial compared to other laser types. When applied to the prostate, the depth of effect does not increase suddenly, it does not pass the capsule of the prostate, if it passes uncontrolledly, erection and the nerves and other tissues passing outside the prostate are negatively affected. The depth of effect of the Greenlight KTP laser is greater than that of the Holmium laser. HoLEP prostatectomy or prostate surgery with HoLEP refers to exactly this procedure.
This stripping process (enucleation; A laser probe is inserted between the prostate capsule and the enlarged prostate tissue, the prostate is stripped from the capsule and thrown into the bladder in several pieces, like open prostate surgery, and the stripped prostate tissue passes through the urinary tract. Since it cannot be removed as is, minced meat is endoscopically used with a device called a morcellator. It is ground into pieces and taken out.
When the results after HoLEP and TUR-P (classical transurethral prostate resection) are compared; No difference was detected between the amount of improvement in voiding rate and symptom score. In addition, the hospital stay and catheter stay are on average one day shorter in HOLEP. However, TUR-P still remains the most ideal surgical treatment. These data are presented when patients make their choice, and the surgery method should be decided by the joint decision of the patient and the surgeon.
GREENLIGHT LASER (LASER): GreenLight (Green Light) as it is called in the field of laser technology, Potassium- Titanyl-Phosphate (KTP) emits laser light at a wavelength of 532nm and binds to the hemoglobin at a wavelength of 542nm in the tissue, showing its effect by vaporizing the vessels and therefore the prostate tissue. In the procedure, KTP-greenlight laser beams are applied to the prostate by entering the urinary tract through a telescope, and the enlarged prostate tissue is vaporized with these beams to the desired extent. This process is called PVP in medicine, that is, photoselective vaporization of the prostate, and the reason why it is called greenlight is because the beam emitted by the laser is green. With this method, prostate surgery can be performed under general, spinal and even local anesthesia in very risky patients. It is entered through the urinary tract through the endoscope, the prostate is vaporized sufficiently and to the desired extent with the laser beams on the placer probe advanced through the endoscope, and an area sufficient for comfortable urination is created, and the obstruction created by the prostate is removed. However, in this method, since no tissue is removed, pathological examination is not performed. Therefore, it is necessary to rule out prostate cancer in the patient by other methods before the surgery.
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