Anaesthetic
GreenLight is performed under general or spinal anaesthetic. The anaesthetist will review any blood thinners, heart and lung history on the morning of surgery.
A walkthrough of what happens on the day, from arrival in the day-surgery unit to the catheter being removed. The same operation is called photoselective vaporisation of the prostate (PVP) in the medical literature.
GreenLight is performed under general or spinal anaesthetic. The anaesthetist will review any blood thinners, heart and lung history on the morning of surgery.
A resectoscope is passed along the urethra. The bladder is inspected first, then the prostatic urethra is visualised under continuous saline irrigation.
The side-firing laser fibre is introduced through the scope. The 532 nm beam is "painted" across the obstructing prostate tissue, vaporising it in thin layers while sealing small blood vessels.1
A small catheter is placed and typically stays in for 24 to 48 hours. Most men are discharged the same day or the following morning, once the urine is clear.
The laser beam travels through water and saline largely unchanged, so the irrigation does not absorb much of its energy. When the beam reaches blood-rich prostate tissue, the haemoglobin in the tissue absorbs the 532 nm light strongly. That absorbed energy heats the tissue above 100 degrees Celsius in a very thin surface layer, which vaporises on contact. A slightly deeper zone is coagulated without being vaporised, and this coagulation zone is what seals small blood vessels as the beam advances.1, 2
Because the laser turns the tissue into steam and tiny particles rather than cutting it into lumps, there is no physical specimen to send to pathology. If there is any pre-operative suspicion of prostate cancer, the options are to do a targeted biopsy beforehand, or to choose an operation that does yield a specimen (such as HoLEP or TURP).
GreenLight uses normal saline as the irrigation fluid. Because the laser does not use an electrical current to cut, there is no need to avoid electrolytes in the irrigation. This removes the historical risk of "TUR syndrome" that could occur with monopolar TURP, where large volumes of electrolyte-free irrigant absorbed into the circulation caused dilutional hyponatraemia.
Below is the full spoken-word transcript of the video at the top of the page, for patients who prefer to read or who are using assistive technology.
The second type of laser treatment that I do and offer is GreenLight vaporisation of the prostate.
This is very good for small prostates, and offers excellent haemostatic capabilities.1, 2
The laser fires from the side, we put the resectoscope in, and it vaporises the tissue.
At the end, you have a usually clear channel, and patients can void and pass urine through this.
Although some studies have shown good outcomes,2 there is a concern that the re-operation rate might be quite high with the GreenLight vaporisation technique,4 and I use it selectively in patients with smaller prostates, or patients who are on anti-coagulation therapies.
So it is another treatment that I use, and I tailor the treatment according to the patient.
Ask for a second opinion on your symptom score, flow studies and prostate size before committing to a treatment plan.