Greenlight laser is an alternative procedure to the reduction of an elarged prostate. It is the particular wavelength of the laser light that gives this laser its name and more importantly its unique attributes. The green light of the laser is avidly absorbed by red; the prostate gland has a very good blood supply and may be considered biologically red. The prostate gland, therefore, is an excellent target for the greenlight laser in achieving vaporisation of tissue. The laser is able to vaporise prostate tissue, but because of only shallow conduction (or scattering) of the laser beyond the zone of vaporisation, sufficient surrounding coagulation means that the procedure is essentially bloodless. Vaporisation of the prostate using the Greenlight laser (Photoselective vaporisation of the prostate – PVP) is the only true surgical treatment of the procedure where there is an insignificant risk of heavy bleeding or the need for a blood transfusion.
The evolution of the Greenlight laser over the last 15 years has been based on technology allowing ever higher power delivery, hence more efficient vaporisation . The 80 Watt Greenlight PV system was introduced into the UK in 2002. This machine featured a unique rapidly pulsed generator that meant almost continuous delivery of the 80 Watts of laser energy. In 2006/7, this was replaced by the High Performance System.
The Greenlight HPS. This machine was capable of delivering 120 Watts of continuous laser energy allowing much faster vaporisation of prostate tissue. The Greenlight XPS laser system in combination with MOxY fibre is twice as efficient as this last model, more power being delivered to a wider surface area. This means quick procedures with shorter anaesthetics and better than ever tissue removal, whilst maintaining the unique, exceptional quality of ensuring none or very minimal bleeding during the procedure.
The Operation and Recovery
What kind of anaesthetic?
Greenlight XPS laser vaporisation of the prostate, also known as Photoselective Vapourisation of the Prostate (PVP), may be performed under general or regional local anaesthesia.
How is it done?
The procedure involves the passage of a specialised telescope down the water pipe or urethra and through that, the MOxY laser fibre. Vaporisation of the prostate is then performed under direct vision. This continues until a wide channel is created through the prostate gland. A standard urinary catheter or drainage tube is usually placed down the urethra into the bladder at the end of the procedure. This may be removed either later the same day or the morning after.
How long does it take?
The length of time of vaporisation required and therefore how long the procedure takes, is determined by the size of the prostate. Other factors such as the presence or otherwise of a catheter and in particular the experience of the surgeon not only influences the speed of the procedure but also the volume of tissue removed. Based on current experience the procedure can take between 15 minutes and one hour. Exceptional cases may require a longer procedure.
How long am I in hospital?
Unlike any of the other operations available, Greenlight laser vaporisation of the prostate is the ONLY procedure that can reliably offer a day case option whatever the size of the prostate. Some patients may stay one night in hospital due to unrelated issues or through personal choice.
I encourage an unrestricted return to normal activities as quickly as patient confidence allows. The timing of this may vary from patient to patient. It is probably best to avoid any exertion, heavy lifting, straining etc for a week or so after the operation. This includes sexual activity.
There may be some discomfort or burning when passing urine in the first day or two, and this may continue at a low level for a bit longer, usually settling within the first 3 weeks. Similarly, although the procedure itself is virtually bloodless, it is not that unusual to see some blood in the urine on and off over the first few weeks. This is normal.
In the early phase following the procedure, the first positive changes will be in the strength of the urine stream. Improvements in other urinary symptoms, such as getting up at night to pass urine, going frequently during the day, inability to hold on etc, may take longer to be seen and can vary between days, weeks or even months to get as good as they are going to be.
The enemy of any surgery is infection and an infection in the urine after this surgery may mean a slower pattern of recovery all-round. Symptoms such as ongoing or worsening burning on passing urine, feeling unwell or high temperatures require early consultation with your surgeon or GP.
Who is suitable for Greenlight laser surgery?
ALL men with symptoms that relate to the obstruction of outflow of urine from the bladder because of prostate disease are suitable for this kind of surgery. Even if they have had surgery before.
Compared to all other surgical options, Greenlight laser surgery has advantages in terms of:
For younger men
- A short hospital stay
- A rapid return to normal activities, including work
- The least risk of impact on sexual function.
For older men
- A short hospital stay
- A rapid return to normal activities
- A zero risk of heavy blood loss and the need for blood transfusion, whatever the size of the prostate
- An exceptional safety profile for those with other medical conditions.
For men taking antiplatelet or anticoagulant therapy, eg aspirin, clopidogril, warfarin, Greenlight laser surgery has a proven safety profile that no other prostate surgery can offer. Indeed, most surgeons would ask patients to stop these medications prior to surgery. This reduces the risk of heavy bleeding, eg during and after TURP, but is associated with a proven small risk in cardiovascular complications after surgery, including strokes and heart attacks.