Holmium laser enucleation of the prostate, known as HoLEP, is an anatomical endoscopic procedure for benign prostatic hyperplasia that depends on a chain of equipment working together. A hospital starting a programme needs a holmium laser and fibres, a continuous-flow resectoscope, a camera system, irrigation and a morcellator. This guide answers what is HoLEP in urology from the equipment angle and lists what a department must have in place before the first case.
What is HoLEP in urology: the procedure in brief
HoLEP uses a holmium laser through a resectoscope to separate the adenoma of the prostate from its capsule in one or more lobes, a technique known as enucleation. The enucleated tissue is pushed into the bladder, where it is cut into small pieces by a morcellator and removed. The equipment must therefore work in two phases: laser enucleation and morcellation.
Whether HoLEP is appropriate for a patient is for the surgeon to decide. For the buyer, the important point is that the procedure has a learning curve, so a training plan and a complete, reliable set of equipment matter as much as the laser itself. See also HoLEP vs TURP and bipolar enucleation.
The holmium laser and fibres
The laser is the core of the system. MegaPulse 70+ is a 70 W holmium:YAG laser designed for stone treatment and soft-tissue work including HoLEP in BPH. It offers 0.2 to 5 J pulse energy and 3 to 60 Hz frequency at 2100 nm, Lithotripsy, Soft Tissue and Expert modes, RFID detection of the sterile fibre and its diameter, a double-pedal footswitch with standby and a blast shield.
Enucleation fibres differ from stone fibres in diameter and are often single-use, so check which are approved for your laser and how many you need per case. The room also needs laser safety measures: wavelength-rated eyewear, signage and a trained safety officer. For more on the device see MegaPulse 70+.
Continuous-flow resectoscope and camera
A continuous-flow resectoscope keeps the bladder from filling and gives a clear view during enucleation. SHARK uses continuous-irrigation double sheaths in 22/24 Fr and 24/26 Fr sizes, a 360 degree rotatable inner sheath, enlarged irrigation taps, a redesigned electrode fork and snap-on couplings. It is compatible with the ENDOCAM Logic HD PENDUAL camera head.
Match the telescope, sheath, working element, laser fibre guide and camera, and keep spare telescopes. Choose a camera and monitor chain with sufficient image quality for fine dissection; see 4K endoscope camera systems.
Morcellator and irrigation
The morcellator removes enucleated tissue. PIRANHA is designed to work with SHARK resectoscopes and consists of the PIRANHA morcescope, a suction pump set and the Vmax blade, available as disposable and reusable. The morcescope has two irrigation channels and a 5 mm working channel, fits 24 Fr and 26 Fr outer sheaths and has an automatic valve against water loss. The blade runs at 1500 rpm.
The suction pump uses a separate container so that tissue remains suitable for histology, and a footswitch toggles between PIRANHA mode and suction mode. Plan irrigation as well, with bags of irrigation fluid and a pump or suitable gravity set-up per your protocol; see PIRANHA morcellator and prostate morcellator guide.
Starting a program: checklist and next steps
Before the first case, confirm the laser, fibres, resectoscope sets, morcellator and blades, camera, monitor, irrigation, electrosurgical backup, catheters and a trained team. Plan training and proctoring with the manufacturer or an experienced centre, and a maintenance contract for the laser and the camera. Check UAE device registration and facility approval requirements with the relevant authorities.
Beckfinity can supply the complete Richard Wolf chain and help plan your HoLEP programme, including training and service support. Contact our specialists for a quotation or consultation.
Frequently asked questions
What is HoLEP in urology?
Holmium laser enucleation of the prostate, an endoscopic procedure for BPH in which prostate tissue is separated with a holmium laser and then removed by morcellation.
What equipment is needed for HoLEP?
A holmium laser and fibres, a continuous-flow resectoscope, camera and monitor, irrigation, a morcellator with blades, and laser safety equipment.
Can PIRANHA be used with SHARK?
Yes. PIRANHA is designed to work with SHARK resectoscopes and fits 24 Fr and 26 Fr outer sheaths.
Does the tissue remain usable for histology?
PIRANHA's suction pump has a separate container so that tissue remains suitable for histology, according to the manufacturer.
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