Surgery
Real-life MoLEP cases: Case number 6 - a biggish 160 cc prostate
Dr. Fernando Gómez Sancha · ICUA
Dr. Fernando Gómez Sancha · YouTube
Language: English. YouTube audio metadata.
Surgical content for professionals. Contains footage of an operation.
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About this video
An en-bloc MoLEP with early apical release in a 160 cc prostate. Because of the large median lobe, the surgeon chose to begin enucleation without entering the bladder first. The description frames this as a precaution against an instrument-related sphincter split, not as an injury that occurred in the case.
This is a big prostate gland. The median lobe was so big that I chose not to enter the bladder at the beginning of the procedure to prevent a 12 0'clock sphincter split caused by the scope and just proceeded to start the en-bloc enucleation with an early apical release. MOSES as helpful as ever with such large gland. Hope you enjoy it.
Documented details and sources
Only details explicitly stated in the sources. Missing information does not mean it did not occur.
- En bloc
The median lobe was so big that I chose not to enter the bladder at the beginning of the procedure to prevent a 12 0'clock sphincter split caused by the scope and just proceeded to start the en-bloc enucleation with an early apical release. MOSES as helpful as ever with such large gland. Hope you enjoy it.
- MOSES / MoLEP
Real-life MoLEP cases: Case number 6 - a biggish 160 cc prostate
- Early apical release
The median lobe was so big that I chose not to enter the bladder at the beginning of the procedure to prevent a 12 0'clock sphincter split caused by the scope and just proceeded to start the en-bloc enucleation with an early apical release. MOSES as helpful as ever with such large gland. Hope you enjoy it.
- 160 cc
Real-life MoLEP cases: Case number 6 - a biggish 160 cc prostate
Source checked: 2026-10-06.
Available transcript · English
Subtitles exported from the original-language YouTube Studio editor. Not clinically reviewed; source identity and timestamps verified, full audio coverage not verified.
They may contain transcription or translation errors; check the explanation in the video.
- [Music] you're on the road I'm sorry we have a large facility look at the camp oh yes it was a plant on particular monitor Artemis never almost el que la cabeza del percent agree with us what my status if I sell my separate I stop effect Union started off in a speedo ok so here we are another piece this is very large prostate a man who has not had had any complication just bothersome symptoms I don't want to force the entry into the bladder because if I do that I will probably speak stinker you midlife you see when you force too much it was already starting to speed so I'd rather start the innovation and then have a look at the letter at the end so nice estimation of this first area is 160
- CC actually already started splitting so I didn't want to force anymore because we can let say compromised center function in the very beginning of the operation I'm going to mark the see the screen turns here it's no singing very nicely I'm happy with this landmark let's say in the kitchen yeah to come up the Wi-Fi that's the area so despite marking the white line below the Roman column it's quite normal in the very large plants that we have to come this far at the optical level last thing I wanted to do is detects the attachments of the Roma to the stinker to try to make things easier for later on in the precision but usually I like to stop it in the lower aspect so from 3 o'clock to 6 o'clock so when we enter in the
- pin we don't stretch the string for in this region you know the fact of deliberate this generates a little better ourselves towards the side here I'm going to use the tip of the spoke to find the proper imitation same that's it I think that's a good good inflation thing and we'll do the same thing on the on the other side yes do a little bit technical section at the beginning to make sure that we find all the right depth of the poem and now we follow the white bone then to make both tents websites thank you published where the like line of attack or the line intersection here we're going to develop the exterior aspect we are using the Moses technology for this operation provides very excellent cutting the correlation properties and it
- allows us to progress relative asked in here and then to go a little bit closer to their normal division is saying that this plane is a little bit flimsy or thin interesting a bit closer but I will focus on this first airplane later on in the equation animate object or moment no no we concentrate on needing a genetics which is the main concern at the beginning of the procedure and that's let's say this to your prospects here they come up the ethical level where I want to try to liberate the interior effects from the simpler and the poor strike itself this paper as asbestos all time so here I'm going to come out to the fiber trying to follow the white line that will make a cut on the constant just trying to watch the effects from the painful
- then I'll go and look for the good plan the strategy to do with the transitions initially we are happening dissect the Africa globe without any key in its filter infamous or out of the chocolate so you have been able to detach the lecture on topics snake from the stink fall coming all the way up to let's drop of blood fibers now I will concentrate on the other side of the attics this is the sphincter this is the white line you see how important it is to have a white line to tell me the exact location and sinker and many times we do follicly we have marked the location of the apex it might be difficult recognize one reason you might get into trouble and think this whole pit work is designed to United say ever think that thanks a little while can we
- reach the apex but once it is released we can relax one precedes and you create the enormous in the capsule following this circle first off line it at section and at the top coming on Toonami this is still from pipes at 12:04 and it's leaking cross towards the other side we see that the other side so we may be finishing the article divination until you leave here of course I don't want to take the wrong route and find to keep the mount fiber as up as I want this thing is already further back so we are working in an area between released from the spoonful so I am not worrying about this thing anymore on here even thoughts in side to side to check at the end maybe sometimes you could leave a small amount of tissue at
- the other polymer it's a river how to control it to get with this ability that you see that beautiful aspect to this technique is lots we are integrating a very small column by innovating with small family they can pop a claim view because leaving your names on believing what we saw before the waters from beginning up so fast on cleaning the media in the relation medium so become perfectly sleep what is Senate nation falls many times before productively we have middle of a new poet in the world today is living the blog is been taking it on going into the bottle name on walks thinking it out is going to be much more difficult that's good sometimes this official can get on the way unlock a little bit for infinity not far just don't pay
- too much attention to that if you're following the right let's say angle right for leaving when you momentarily don't see them completely continue working of course if you cannot sleep for a long time you should be powerful I try to get that really that's the it's the light cable that went off let's go again I'm trying to dissect anything at the interior plane there's a nest in there once the swing is numerated it's important to take in carry a uniform it's the line intersection if you find any resistance moving let's go step back you know we spoke a little bit too much the effects and check what's going on how many times you see there is some he touched on magnets because when you have a good perspective of what is
- going on it's very easy to decide what to do next where you feel tip let's say dissecting on dissecting and you never get back which is a pain temptation because you get that's me I'm happy when you can't progress or you might do some information if you don't check a little bit more article or what's going on so you know unless you can see that anything is going perfectly and have no assistance not watching me it's better to pick up oh no we have seen the compound a plane using its limit spongy so maybe we're getting into a profound zone then we did something good 19 is on Delta follow just being an idiot more thoughtful see that he must be now arriving to the equator of the Advanced section so for now all the angles
- are going to change we are inspecting we almost fairy power still normal initially the angles are opening towards the external watch the lateral you want the interior towards the exterior and now you need to close these angles by pointing the fiber a little bit launch it really normal you see you could launch the Anoma so in dissect the plane but it has very many chances of a damaging the faction this is small it's a discrepancy in the planes and times it happens when you go from the posterior to the lateral times the rotten log which is luckily in the middle purchased the factual downwards and in departments of the middle know and the lateral log there might be some discrepancy in the plane
- it's not that you are following the wrong plane it's your dissecting two different spaces laughs oh no it's a footprint and here you get to the middle of footprint so in between sometimes we find a discrepancy many times you just have to cut through it to connect both planes okay so I think it's enough for the moment in this side I'm going to this we follow the dissection intentionally trying to go to the other side and try to take it to a similar depth of dissection it's not that for dissection the first we want to keep a uniform progression from the ethics to the bladder neck circumferentially it's again it seems like a ligament here this is what I call the lignin is the transition from the lower plane to the lateral plane and sometimes you
- follow this plane you look first if you have to go up this way but then you go lateral and you find out there's more tissue in them this is normal we don't sleep in a tree no technique because actually they cut off the side at 5 and 7 at the side of the middle aww i'm exactly in this area so it's the first time it's needs when you know one will be in block a new creation we took a while to understand what is going on why we would see that apparent discrepancy in the in the dissection planned so here we are also progressing towards the bladder neck [Music] we are you can follow their fur at the frosting you only have to get close to the prostate so you don't get inflated to st. Russell but here when the plane is not completely clear but we
- will follow the shape of the pasta it's a bit long but we are enjoying the its neutrality different sauce is provided by Moses gives us a lot of confidence key to progress and it's a not worry so much about the most assists us the quality and classes as we go is excellent and it's a very good plan let's see what happens here you see you have to look back many times you check because the prostate is not a perfect sphere and sometimes we might have taken a slightly deeper plane maybe the plane does become inside totally with the one you're developing so you have to make things nothing better connect the planes when there's no natural x-ray connection and it's quite easy to figure out what we're doing because basically
- what you want to do is to dissect the Noma and push it into the others when you want to go around it sequentially not very difficult understand not very difficult to execute we are we are let's again take a beautiful plane we found a partner and you see it's more less coincides with the plane you are following one here although quality of the paint has changed created in the memory to me this is all and normal so you have to take it out sometimes you cannot tell if you are taking some of the purple from which their normal lives table to me as it's going as it's progressing course here you see the fiber needs to keep really close to the adenoma so we don't insist on the end the capsule mostly Annamma so you don't go into the person
- here this is the area that we found at the beginning that was a little bit looks a little bit thin so if you close to your normal that you've seen to see if we can find a proper plane down here looks very good plane so we try to follow or not on that level I see not correct and then fix the plane we don't go too deep and that's from that region is secure it looks as if this is with its thin in plane but by correcting a little bit we will manage to get a better plan for the continuation of the other section of experiment then we are progressing quite nicely [Music] progressively and you can see this technique yourself continues firing 54 you don't stop too long you are constantly evolving
- constantly dissecting the plane and that means that if you are able to improve the situation every minute you will end up finishing the operation in a very reasonable time let me do a reload technique you have to go back check look very often so that's another advantage of this and block technique but she's very fast you can progress really fast with it that's the sphere plane you have a much better plan than we have say here where the plane started changing direction you seem absolutely clean see here what we managed to correct the situation all right sir not much focus in the interior I think we are have done quite a lot of the posterior dissection the plane was changing direction going upwards blood or neck remember we didn't enter
- the bladder in this patient to fill the operation because the anomalous quite large and the middle lobe so we have to push then the scope down too much I decided to start trigger we have information about the bladder because we do that and also some before the operation you look normal it's why I take this so let's say most people who try to get into the ladder to see what's in the bladder and the first time in the procedure but I think you have the option information and you can start your initiation and then when I check the blood will be in there we are that's the entry to the water you can see the vertical fibers yeah responding to the one mark that's a poster from the bottle that it's ballooning because of the water pressure in
- such a small spacer what my spectacular method Isaac's a little bit from the seat here there's some dissections in the fossa it's peeled off the the bladder neck and that can pose sometimes a little bit of bleeding so I think it's better when you're going to enter the matter inspector three puncture early so the pressure is relieved and the flow of water can enter the bladder and this will minimize the amount of muscle dissection that's going to take place and then the meaning coming from the the fossa will be less as well very nicely my next step is going to be to try to say bring the bladder neck downwards don't say exterior specs for that we have to release some of the lateral afterload still there gladinet people try to tap it to come or towards the
- sides of the middle okay we love sitting on the middle we're coming at the velocity of a little oh yeah Mr Blair this is the you oh you see it's very very close and now we can look at the bladder or something I will try to do different facility that let's look at it it's a big bladder so remember what the mule is not very tough in here so we will be very components feel the same job on the other side you see that the quality of the view has fallen a little bit will be due to the fact that we have no longer have this small chamber that we are irrigating there is what we're going in there in the bladder and some water flow is really difficult to that's the the other side of the government
- getting lucky she's making the cuts of the bladder neck and you follow the same potential at the latter neck here again you have to be careful because the UO it's likely to be very close as well right in a pass where you're living and quite sure now that we want damages by following this this dissection route look whoops this is almost done man the stuff to release the lower aspect before that I'm going to try to connect say relax file will be posted here see if we can take and also remember keep the fire the fiber very personally yeah no I'm not not really capsule we don't want to fire here I want to fire up there we release that normal arrested me without damaging the capsule or the point where you can do a retro peg on filtration
- I'm going to push the normal in the corner of liquid lipstick a little bit and of course I can expose this this region to the paranormal baby it's too plainly actually follow me I'm coming up to see if we can come out that's the bladder neck level that's possibly very close to here to the bladder neck what pushing a little bit with the scope to generate some it's the claim there's a leader here right here see we can control it see most of these very important spaces even when there is a pumping leader the condition we control it very easily and this is one of the advantages over the low-power laser I think you struggle much more keen to populate pumping vessels with flow power you have to be careful
- here because your should be close and on the other side we could see that we were more medial than the you over here yeah here we are we're right at the edge so I'm going to keep my incision of the bladder neck a little bit more video make sure that we don't damage the you oh here we are let's see if we managed our objective I'm going to check position of in you all know it's quite safe and now you have taken the battlefield a little bit more video you can release this tissue without damaging the you are if the other side I think we are now in a position to try to treat the Nama into the bladder just by pushing it carefully about the prostatic urethra you see this log was almost wanting to go in but many times it's this possibility is limited by the
- remaining attachments at 6 o'clock if the pentacle is very wide sometimes it's difficult to push the anomaly in the bladder so it's nice to to say make it less wide to catch the attachment of six o'clock towards the midline so the pinch but the prostate willing used to rotate is much more and you see now we managed to push one knob in the bladder and now the analog so the prostate has flipped completely you can see that a split might be but we react the clarinet attachment that we are going to and notice that I have placed my Cyril to support then women Mitel idiot no it's completely free huh and this is the prostatic fossa and that is distinct enough so let's check the status for a moment come on so this therefore a big
- prostate was possibly a very very fast innovation time the nurse is telling me that it was about 15 minutes I'm going to check the quality Venice classes usually with most as we get very good kind of status as we go maybe I went a little fast do you pay any attention to even stresses throughout the procedure and now I have to spend a little bit more time doing it so you have to find the balance between speed of dissection and quality tennis classes and not always we get it right and sometimes we go too fast but we want to go fast in the sense that we don't want to lose our time if you can do this operation in half an hour I think it's better for the patient we do short a procedure shorter with all the stress time
- we told you I'm quite keep assuring safe and okay yeah that's you that looks like an opening that it's just not important to populate the vessels of the level of the bladder neck contentious where meaning can happen sometimes with the water inflow they look towards the bladder and you don't see them very well you have to get to the edge to see like this [ __ ] them especially minimal bleeding but it could compromise the most relation there we are let's see anteriorly maybe there is some video mirror that it's making our life a little bit less specie it's quite difficult to reach up there is that maybe some both of them so we can confirm you don't need anything screaming the minutes in the fastest rate will be a much better ability
- throughout most nations in computing the efforts yeah I'm using a full-power this course the tissue effect depends not only on the power but also on the working distance you can tailor the effect you want maintaining is going a little bit faster here for example I will give the population of them much closer to the ampere Viktor leader yeah I think follow up on its own on for I can see any job you see we can stop making a fuss if TCP 180 there we are now do you have an overall much better vision you know okay all right do the ultrasound yeah okay then I calculate tomato PR and delimiters some people call your checking the transverse and ap and here posterior longitudinal view of the officer is very impressive
- white cavity we have generated and now we're going to take out the fiber lace the lace from stand by and see the prostate the Nama feeling that our home of stuff okay [Music] make okay mr. there we are left inside again this is the different scope that I use for my solution I'm going to put my plate near the ladder neck but I'm going to bring it up I am in a fixed position trying to look for the keep under there Noma mostly I want to push their normality push the blade a little bit inside interestingly this plate has no logo and if if I keep the blade in this distance from the telescope I can have some information of where is the bladder you see I don't see it in detail but I can see that the color of the water and
- the sides of the later it's a little black which means that there's no bladder tissue nearby the geranium oscillator has changed very deeply what we do in the sense that before sometimes modulation would take longer than the mostly a new patient face and now it tends to be very fast because if this most like to choose the tissue at a rate of 10 or 11 grams per minute we are working today we have a session with five cases we started at 3:30 and we hope to be finishing by 6:30 so typically we can do five cases in six hours of course we need a very good teamwork and the collaboration of the operating theatre personnel the water is not so good no no I can't I wanna maybe I'm seeing that the bags the bags
- are not full and I'm telling my people to check keep an eye on the irrigation bags I don't want to get I want to be without inflow so sometimes you don't use a second irrigation some people use the second irrigation because they feel that the inflow is better and they feel more safe having a second arrogation with the wolf system what I have seen is that the amount of water coming in and the water coming out with more solution quite balanced the bladder keeps the standard drug procedure the only thing you have to keep in to keep in mind is to check that the modulation is efficient you see one more flashing is efficient the mouth of the blade is covered by tissue so there will be a lot of tissue coming out and a reasonable amount of water whereas if we have
- an inefficient modulation there will be a lot of suction of water and the bladder can empty the batter empties there's a chance to catch the bladder with a motion later and use an alarm condition so that's why it's important to keep let's say checking motivation is an active situation where your brain has to be working you have to pay attention to detail to make sure that no accident happens we do 8090 cases per month and we rarely rarely rarely see an accident with modulation typically if you can let's say follow the rules of modulation safety rules in translation it's quite unusual that you will cause any damage but of course you need the help of the people in the operating room to check lie on the water you're looking at the screen be
- looking after the water so complete efficient teamwork that makes this procedure a success where you can see the piranha in action which is coming out really fast and I can do continuous oscillation you know one of the drawbacks of the piranha is that the standard bottles that collect the water are little bit small there are three meters so when you have finished the bottle we have to stop the modulation we'd have to change the bottle you have to generate bathroom again and then you have to start again but we found that these bigger bottles in the market so we use the 5 liter bottle it gives us an extra let's say a lot of time that we can keep on more slating and nowadays most of these grants even when they're quite big can be say performed
- with one bottle only so in this case it's only a small remnant left need to check check the bladder check the pasta to see that there's not no significant amount of issue or tissue paper small tissue fragment no I think we finished like typically when you can do the actually wash solution with good visibility throughout that's not important being from the faucet so I can safely put the gasoline and the hem status will be perfect thank you for your attention