ThuLEP Explained: Thulium Laser Enucleation of the Prostate

What thulium laser enucleation is

In anatomical enucleation the surgeon follows the plane between the adenoma and the surgical capsule and separates the lobes, which are then pushed into the bladder and morcellated. ThuLEP uses a thulium laser for this dissection and for haemostasis. The principle matches HoLEP, hence the HoLEP vs ThuLEP question.

Thulium lasers emit around 2 µm at a wavelength strongly absorbed by water, giving a shallow depth effect and fine cutting. The original ThuLEP technique used thulium:YAG; fiber-based thulium systems, called ThuFLEP, are a newer development.

Equipment for thulium laser enucleation

A ThuLEP tower contains the thulium laser, a laser fiber, a continuous-flow resectoscope, a camera and monitor, irrigation and a morcellator. The Pulvis 60+ is a Class 4 thulium fiber laser (60 W, 1920–1960 nm) that Richard Wolf presents for anatomical endoscopic enucleation of the prostate as an alternative to HoLEP; it also handles stone dusting and TUR-B.

Pulvis 60+ runs on a standard wall outlet with no high-voltage supply, emits in continuous or pulsed mode and uses fibers from 150 to 1,000 µm. The SHARK resectoscope provides the sheaths, and PIRANHA performs morcellation.

• Thulium laser with fiber
• Continuous-flow resectoscope
• Morcellator with suction
• Camera, monitor and irrigation
• Laser safety measures

HoLEP vs ThuLEP: what changes for the department

From the department view the difference is the laser. Holmium is a pulsed solid-state laser at 2100 nm, thulium emits at around 1940 nm and can work in continuous mode. Procedure steps, resectoscope and morcellator remain broadly the same, so a department with an enucleation tower can often compare the two energy sources without rebuilding everything.

Pulvis 60+ is compact: 47 × 94 × 81 cm and 100 kg on castors, compared with the MegaPulse 70+ at 595 × 1200 × 1074 mm and 200 kg. For the holmium side, see holmium laser enucleation equipment and the thulium vs holmium comparison.

Thulium laser for BPH: planning and training

Introducing any enucleation technique needs structured training: proctoring, supervised cases, and a defined case volume to maintain skills. Plan staff for the laser, morcellation and the post-operative pathway. The surgeon’s choice between holmium and thulium is a clinical decision.

Also plan the room: laser warning signage, eyewear for the entire team, door interlocks as appropriate and the power supply. Pulvis 60+ is designed for a standard outlet, which can simplify a rooms upgrade.

What to ask the supplier

Ask for the laser data sheet, fiber compatibility, service plan and the training offered. Ask how the morcellator and resectoscope are matched to the laser, and whether the supplier can deliver the whole tower. Check registration with MOHAP, DHA or DOH as requirements change.

Beckfinity can prepare a ThuLEP tower with laser, resectoscope and morcellator for your department. Request a quote through the contact page; see also the Pulvis thulium fiber laser article.