Endoscopic Holmium Laser Enucleation of the Prostate (HoLEP) in the Human Cadaver: Realism and Feasibility

Introduction: The Endoscopic Holmium Laser Enucleation of the Prostate (HoLEP) technique is efficient but requires experience, learning curve and relevant endoscopic skills. There are several devices available for HoLEP technique training, but Human Cadaver (HC) has never been tested in this purpose. The aim of this study was to evaluate the realism and the feasibility of the HoLEP in a HC. Material and Methods: Fresh male HC were chosen at the anatomy laboratory and were prepared for a three-lobe HoLEP technique. The HC were placed in the lithotomy position with knees extended. The surgical interventions were performed by fellow surgeons supervised by expert surgeons. The model and the surgical intervention were globally evaluated after each procedure. The fellows were asked about the realism and the quality of each step of the surgery. Results: Sixteen HC were operated by 21 fellow surgeons. The endoscopic anatomical landmarks were well-preserved in all subjects. The absence of bleeding facilitated the vision of the operative field. Endoscope and instruments movements into the prostatic urethra were not modified by the cadaveric rigidity. Prostatic enucleation and intravesical morcellation were able to be fully performed without bladder injury. Conclusion: This study has shown that the human cadaver could be used as a training model for the HoLEP technique and could become part of the educational arsenal.