Fig. 1

Illustration of the thulium laser prostate enucleation (ThuLEP) surgical technique. Step 1: Creation of the working space: coagulate the mucosa along the proximal side of the sphincter, sparing the verumontanum, and create the marked line. Step 2: Cut and extend from the marked line to the capsule in the 5 o’clock and 7 o’clock directions. The marked line that is proximal to the verumontanum is spared (in the 6 o’clock direction). Step 3: Extend from the cutting edge in the 5 o’clock and 7 o’clock directions to the 6 o’clock direction. Step 4: Place the guiding tube on the scope sheath and keep dissecting from the 6 o’clock direction to the opposite side (in the 5 to 4 and 3 o’clock directions and in the 7 to 8 and 9 o’clock directions, respectively). Step 5: The tissue in the 12 o’clock direction is relatively thin. Be careful to not cut too deep or shallow while cutting in this direction. Step 6: Cut along the prostate capsule and make a window to the urinary bladder space in the 5 and 7 o’clock directions. Step 7: Extend the cutting edge from the 5 and 7 o’clock directions to the 6 o’clock direction. Extend the edge along the lateral wall in the 12 o’clock direction. Step 8: Push the adenoma tissue into the bladder space, check the bleeder, and then perform the morcellation procedure