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Glamorgan Urology: Green Light Laser

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Green Light Laser

Green Light Laser Prostate Surgery

Glamorgan Urology consultants Andrew Thomas and Robert Skyrme are experts in green light laser prostate surgery for benign prostate disease (BPH). We are highly experienced in this minimally invasive procedure and have performed over 700 cases over the last 8 years.

Mr Thomas was the first surgeon in Wales and one of the first surgeons in the UK to perform green light laser prostate surgery in 2003.

Mr Thomas has trained many surgeons in the UK and Europe to perform this technique.

In September 2010, American Medical Systems (AMS) announced a Europen trial of Green light laser v TURP, The Goliath Trial. Mr Thomas was chosen to co-lead the trial with Professor Alex Bachmann. 292 patients will be recruited into this study over the next 2 years at 38 centres around Europe.

Glamorgan Urology have invested in the new third generation Green light laser, the 180 watt XPS system with the new Moxy laser fibre. This is the only XPS laser in Wales.

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Green light laser XPS console

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Moxy laser fibre

The XPS laser has several advantages over the 120 watt HPS laser:

  • 50% more power for quicker operating times

  • enables larger sized prostate glands to be treated

  • improved control of bleeding vessels with ‘Tru Coag”

  • a more durable fibre, for more efficient vaporization.

What is Green Light Laser Surgery?

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With Green light laser surgery, the energy from the laser is delivered via a moxy fibre (shown above). This causes vaporization of the enlarged prostate in a blood-less manner, allowing for safer surgery on a day case basis. The tissue interaction is termed ‘photoselective vaporization of the prostate’ (PVP). The technique is often described as ‘peeling an onion away in layers from the inside’.

Who can benefit from this treatment?

All men with benign prostate disease (BPH) are candidates for green light laser PVP. These include men with:

  • LUTS lower urinary tract symptoms: difficulty passing urine or increased urine frequency
  • Retention of urine, who have a catheter in place.
  • Recurrent urinary tract infections due to BPH
  • Bladder stones due to BPH
  • BPH who are taking warfarin
  • Men with very large prostate glands (> 100mls in size)

Some patients who have prostate cancer, may also be suitable.

What can I expect from the procedure?

The procedure is performed under a general anaesthetic. It usually takes between 45 and 90 minutes, depending largely on the size of the prostate gland to be lasered. Antibiotics are given at the time of the operation. The thin moxy laser fibre is positioned within the laserscope and is passed up through the urethra to deliver the treatment. Following the procedure, a urethral catheter is inserted. It is usually removed at 7am the following morning after evening surgery. Some patients with the most enlarged prostates have a suprapubic catheter, and this is usually left in place for a week until normal voiding has resumed. Five days of antibiotics (ciprofloxacin 500mg twice per day) is normally taken after the procedure.

What are the main advantages of Green light laser over traditional surgery?

There is very little blood loss compared with the standard operation known as TURP (Transurethral Resection of the Prostate). This means a quicker recovery for patients and a quicker return to normal activities. Recovery is also improved because patients are not anaemic and have not absorbed irrigation fluid produced during TURP which can cause the serious condition of so called ‘TUR Syndrome’. No tissue is available for histology following the procedure. It is therefore important that prostate cancer is excluded by a urologist prior to GreenLight laser treatment.

Clinical experience of Green Light Laser PVP

GreenLight laser surgery was first performed in the UK in October 2002 and approved by the National Institute for Clinical Excellence in May 2005.
Glamorgan Urology Consultants have a comprehensive experience of green light surgery in both their NHS and private practices. Over the last 8 years we have performed over 450 cases in the NHS and over 250 cases private clinics. We have refined our green light laser technique over the years, since using the first 80 watt PV system in 2003, through to the HPS 120 watt system in 2007 and finally the new 180 watt XPS laser in October 2010.

Studies show there is no increase in the need for repeat procedures following GreenLight laser and that there are reduced side effects compared to TURP. GreenLight laser prostate surgery is now fully established and is the recommended operation of choice for men with BPH at Glamorgan Urology.

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