by
Sean Ruck, Contributing Editor | March 28, 2014
From the March 2014 issue of HealthCare Business News magazine
Even if the idea made sense, the first trials didn’t support the idea. “The trials in the late ‘80s and early ‘90s failed miserably,” says Dr. Carson Wong, chief of the division of urology at University Hospitals Ahuja Medical Center, medical director, Center for Minimally Invasive and Robotic Surgery, University Hospitals Parma Medical Center, director of minimally invasive and robotic surgery, SouthWest Urology, LLC. all of Cleveland, Ohio.
The patients that went through the early laser treatments for BPH had a tough time. The lasers heated the tissue enough to change its consistency and cause it to coagulate, but left the dead tissue to slough off and eventually get passed in the urine. “It was worse to live with the discomfort from the surgery than the discomfort from before the operation,” Wong says.
Still, the trials provided some useful information setting the stage for improvements in surgical laser technology.
“The failures were good because they allowed us to see what the shortcomings were,” says Wong. “The trials showed that the lasers didn’t generate enough heat and based on that information, new lasers were developed around 1995.”
As with most emerging technology, adoption was slow, in part, because people anticipated updates and upgrades. The first greenlight lasers to be clinically workable for treating BPH came in at 80 watts. Around 2006, technological advancements upped the power to 120 and roughly two years ago, a 180 watt version came out. More power lead to a faster procedure. The use of lasers also allowed those with heart conditions or other factors that precluded them from TURP to have a minimally invasive option to treat BPH.
Even with the updates adoption was still slow.
The holmium laser treatment also requires extra steps. Its wavelength is absorbed by water, generating heat. The heat is used to coagulate and cut away prostate tissue. After the tissue is cut away, it’s pushed into the bladder and a morcellator is inserted into the bladder to grind up the tissue to allow it to be removed from the bladder.
“It was a very, very steep learning curve to become efficient and effective in performing the procedure,” says Wong. “In certain hands, the procedure is done very well, but the people that can do that are at the top of the pyramid. For general adoption by urologists as a community, it’s time-consuming to learn and you have to go through a lot of patients who might not have optimal results.”
The financial investment was another obstacle. The units range widely depending on which type of laser and how much power is used, but regardless they all ring in significantly higher than the generators and loops used for TURP.
