摘要
wollm thulium laser has become widely accepted because of the resultant excellent homeostasis and rapid vapo rization in prostatectomy. It is necessary for us to increase the surgical efficiency because of increasing numbers of largersized, eld erly and highrisk BPH patients. We have made efforts to achieve this goal through continued improvement of the 2~m thu lium laser equipment, innovative methods tangerine technique, reasonable teaching mode and easily grasped learning curve. We prove it necessary and feasible to increase the efficiency of 2μm thulium laser resection of the prostate. Transurethral resection of the prostate （TURP） is generally considered the ＇gold standard＇ for the surgical treatment of benign prostatic hyperplasia （BPH）,1 but its use is generally restricted to small and medium sized prostates.2 The complications and morbidities that have been related to this pro cedure, which include blood loss and distur bances in the fluid balance, have created a need for the development and investigation of newer techniques. Several laser devices working at various wavelengths have been introduced in the last few decades.3 One of these, the 2~tm thulium laser, is a surgical laser with optional continuous or pulse wave modes and a wavelength tunable from 1.75 to 2.22 ].tm.4 This laser presents many advantages over the holmium laser, such as an improved spatial beam quality, a more precise tissue incision and the capacity to operate in optional continuouswave or pulse modes.5＇6 Since 2004, we have used the thu lium laser in clinical practice primarily for urogenital endoscopic procedures, and its use has become widely accepted because ofthe resultant excellent homeostasis and rapid vaporization. TURP AND OPEN PROSTATECTOMY TECHNIQUES Considering the size of China＇s ageing popu lation, surgical morbidity is expected to consis tently increase among urological patients. Thus, we expect to treat more and more complex patients suffering from such serious condition., as cardiovascular and cerebrovascular diseases. These highrisk patients cannot tolerate long operation times or significant blood loss. Many consider TURP to be the gold standard for men with prostates from 30 to 80 ml.7 However, there are many patients who have larger transrectal ultrasound adenoma volumes. In these cases, open prostatectomy is chosen over endoscopic approaches, despite the fact that open prostatectomy has been associated with notable perioperative morbidity and lim ited eligibiI/ty for highrisk patients,s Therefore, it is necessary to improve the safety and effec tiveness of those treatment methods that could expand the indications for the surgical treat ment of BPH. Technical advances that work to improve safety and reduce operative time while efficiently removing resected BPH tissue will be of clinical benefit to patients. CONTINUED IMPROVEMENT OF THE 2pm THULIUM LASER EQUIPMENT The development of instruments that allow for safe and reliable prostatic dissections through a flexible endoscope is necessary to address these problems. An ideal dissecting instrument should be precise and capable of achieving effective hemostasis. The RevoLix laser （Lisa Laser Products, KatlenburgLindau, Germany） is a 2wn wavelength thulium laser; its effect on the tissue is restricted to less than 2 ramdeep penetrations, measured from the tip of the fiber.4 At first, the laser was a mobile unit withtunable power of up to 50 W. In an earlier study, although the resected weight of the tissue in the thulium laser resection of the prostate tangerine technique （TmLRPTT） group was significantly less than that in the TURP group, there was no significant difference in the esti mated resected tissue weight between the two groups, as we discerned that 0.45 g of tissue was vaporized every minute with the TmLRPTT.9 Currently, the maximum power of the laser has been improved to 120 W, and theoretically, a mean total of 1.08 g of tissue is vaporized per minute.1~ By combining resection, vaporiza tion and enucleation, the removal rate can be increased to approximately 23 g rain1 in trained hands. Based on our experience, when the laser fibers are inserted into the prostate tissue, the effects of vaporization are enhanced. Furthermore, if we need to coagulate the ves sels, we maintain a small distance between the fiber tip and the tissue. Thus, a decrease in energy effectively prevent vaporization and ensure hemostasis. INNOVATIVE METHODS： TANGERINE TECHNIQUE There are several research articles that describe the techniques for the 2μm thulium laser resection of the prostate, including vaporiza tion, resection and enudeation. When we ini tially used the thulium laser, we attempted several procedures, such as thulium laser incision, thulium laser resection, thulium laser vaporization and thulium laser enucleation. These techniques produced similar results to our early experiences with the holmium laser. However, we believe that the superiority of the present type of laser cannot be reflected by these methods. The 2μm thulium laser is a new sur gical laser with optional continuous or pulse wave modes and a wavelength tunable from 1.75 to 2.22 μm. The continuous wave mode,
wollm thulium laser has become widely accepted because of the resultant excellent homeostasis and rapid vapo rization in prostatectomy. It is necessary for us to increase the surgical efficiency because of increasing numbers of largersized, eld erly and highrisk BPH patients. We have made efforts to achieve this goal through continued improvement of the 2~m thu lium laser equipment, innovative methods tangerine technique, reasonable teaching mode and easily grasped learning curve. We prove it necessary and feasible to increase the efficiency of 2μm thulium laser resection of the prostate. Transurethral resection of the prostate （TURP） is generally considered the ＇gold standard＇ for the surgical treatment of benign prostatic hyperplasia （BPH）,1 but its use is generally restricted to small and medium sized prostates.2 The complications and morbidities that have been related to this pro cedure, which include blood loss and distur bances in the fluid balance, have created a need for the development and investigation of newer techniques. Several laser devices working at various wavelengths have been introduced in the last few decades.3 One of these, the 2~tm thulium laser, is a surgical laser with optional continuous or pulse wave modes and a wavelength tunable from 1.75 to 2.22 ].tm.4 This laser presents many advantages over the holmium laser, such as an improved spatial beam quality, a more precise tissue incision and the capacity to operate in optional continuouswave or pulse modes.5＇6 Since 2004, we have used the thu lium laser in clinical practice primarily for urogenital endoscopic procedures, and its use has become widely accepted because ofthe resultant excellent homeostasis and rapid vaporization. TURP AND OPEN PROSTATECTOMY TECHNIQUES Considering the size of China＇s ageing popu lation, surgical morbidity is expected to consis tently increase among urological patients. Thus, we expect to treat more and more complex patients suffering from such serious condition., as cardiovascular and cerebrovascular diseases. These highrisk patients cannot tolerate long operation times or significant blood loss. Many consider TURP to be the gold standard for men with prostates from 30 to 80 ml.7 However, there are many patients who have larger transrectal ultrasound adenoma volumes. In these cases, open prostatectomy is chosen over endoscopic approaches, despite the fact that open prostatectomy has been associated with notable perioperative morbidity and lim ited eligibiI/ty for highrisk patients,s Therefore, it is necessary to improve the safety and effec tiveness of those treatment methods that could expand the indications for the surgical treat ment of BPH. Technical advances that work to improve safety and reduce operative time while efficiently removing resected BPH tissue will be of clinical benefit to patients. CONTINUED IMPROVEMENT OF THE 2pm THULIUM LASER EQUIPMENT The development of instruments that allow for safe and reliable prostatic dissections through a flexible endoscope is necessary to address these problems. An ideal dissecting instrument should be precise and capable of achieving effective hemostasis. The RevoLix laser （Lisa Laser Products, KatlenburgLindau, Germany） is a 2wn wavelength thulium laser; its effect on the tissue is restricted to less than 2 ramdeep penetrations, measured from the tip of the fiber.4 At first, the laser was a mobile unit withtunable power of up to 50 W. In an earlier study, although the resected weight of the tissue in the thulium laser resection of the prostate tangerine technique （TmLRPTT） group was significantly less than that in the TURP group, there was no significant difference in the esti mated resected tissue weight between the two groups, as we discerned that 0.45 g of tissue was vaporized every minute with the TmLRPTT.9 Currently, the maximum power of the laser has been improved to 120 W, and theoretically, a mean total of 1.08 g of tissue is vaporized per minute.1~ By combining resection, vaporiza tion and enucleation, the removal rate can be increased to approximately 23 g rain1 in trained hands. Based on our experience, when the laser fibers are inserted into the prostate tissue, the effects of vaporization are enhanced. Furthermore, if we need to coagulate the ves sels, we maintain a small distance between the fiber tip and the tissue. Thus, a decrease in energy effectively prevent vaporization and ensure hemostasis. INNOVATIVE METHODS： TANGERINE TECHNIQUE There are several research articles that describe the techniques for the 2μm thulium laser resection of the prostate, including vaporiza tion, resection and enudeation. When we ini tially used the thulium laser, we attempted several procedures, such as thulium laser incision, thulium laser resection, thulium laser vaporization and thulium laser enucleation. These techniques produced similar results to our early experiences with the holmium laser. However, we believe that the superiority of the present type of laser cannot be reflected by these methods. The 2μm thulium laser is a new sur gical laser with optional continuous or pulse wave modes and a wavelength tunable from 1.75 to 2.22 μm. The continuous wave mode,
