Surgery
Real life MoLEP Case Number 5
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
A HoLEP performed with MOSES technology in a small prostate. The source identifies the technique and gland size in qualitative terms, without giving a numerical measurement or postoperative result.
This is a HoLEP procedure with MOSES technology performed on a patient with a small prostate gland.
Documented details and sources
Only details explicitly stated in the sources. Missing information does not mean it did not occur.
- MOSES / MoLEP
Real life MoLEP Case Number 5
Source checked: 2026-10-06.
Available transcript · English
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- well yes so you know we are again this case is a man who is very bothered by his symptoms not responding anymore to medical treatment to some difficulty entering so I'm going to try to do an audio from the financial district I will use the artist to do a small incision in the distal articular Agusta and hopefully I can go in without any force I always thought that not always but I
- think what what is your thought to me is a good thing and I have to say we don't see many and my adults pictures after holmium laser protecting me even using a twenty six twenty seconds hope we don't see logic still hace to see this is the effect of the artists let me see if I can show you its we are looking at the interior Nitra coming out you see it's a minimal minimal mucosal incision not ready that allows us to get a much better wider caliber of the urethra and then the fact that it's only sir let's say linear incision twelve o'clock I think makes it difficult for the reader to look into
- stricture and here we are you can see it's very small gland this mobile and these small glands are quite difficult to operate as first cases in a mutation so I wouldn't recommend starting with such a case let's see that's a really good gel in the latter euros yours as I said I like to do a cystoscopy but I don't like it to be very aggressive because it can produce bleeding not probably not these very small glands right we are five it's six o'clock here we're coming out and here you can see the edge of the sphincter no that's the it's a sphincter so I think
- we can safely do our initial market nearly and then again the same and be on the other side trying to connect with this small gland so we won't take long we're in cutting the top of the pheromone column I'm going to do a little bit of mechanical dissection to try to find the plane of course these smaller glands typically don't have a
- very good plane you can see the little hope for a Valecia that form between the capsule and the uyama so that must be the good good depth of location we're going to gain by Jane both both planes in the midline I'm going to turn the fiber to 12 o'clock to continue with the dissection here you can see that almost immediately the posterior sphincter is released from the effects using the gnosis settings you can see that you get really nice visibility all right here there is not a lot of tissue to dissect in that direction
- would you look at the we're almost at the latter neck regions I'm going to detach the the other lobes electrolux I'm starting by cutting on the as we always do slightly leaf cut on the prostate and then we will try to access the proper plane the cut on the prostate provide very good access as you can see we are dissecting the plane here and we need the cuts there you see so it was a way to preserve the sphincter feel you can see in a white line we continue dissecting we're going to split a little bit of this finger here so we have to be very careful and continue let's say separating this thing from the effects in the white line so here you have to be
- very careful try to come up this way you have a little bit very relation because of the reduced space we are irrigator and the fact that very often the sphincter is closing over the drainage or akiza's very coming up coming up coming up and now I will cut let's say horizontally and continue to see the dissection plea from in viewing in the 12 pirates which is what that's okay normally we are able to release the
- capsule there we are so let's see the other side that's the sphincter see if we can avoid it ethnic on the poster that we did on the other side and here we're coming up here I'm acting a little more for example initially in the prostate on the prostate so you don't want to look for the plane at first but then of course after this incision has been made we can go and look for the proper plane we have to be careful when ascending to check that we do touch the apex from the sphincter in this region so today I'm going to follow the white line as well see the irrigation is not so good the outflow is a little bit impaired
- progressing quite nicely now first we are only left with this se12 about five words to cut and then we pump connected with the plane on the other side so that's that's the on each side since this slide now I'm going to follow the circumferential length by using a non-contact let's say mode I won't try to contact let's say on purpose oh and that's not the energy bill a dissection just following the potential playing around very positive thing in a case like this if I can only make a glove on it it's very sensible to try to enter the bladder
- before we try to get select exterior area here steam you can see expediently you see a good claim but for a thing we're going to clean image photo oriental if you pump on the sides so that's it's good plane I'm following the total points per game okay I can go around the egg normal looking for the right name or at least you know when the plane it's not very easy to distinguish at least you have to seen a unit outside of the capital also you see that there's any sign of dissipation of getting too deep in the capsule and you have to correct your own trajectory I think it's even less concerning to leave small
- amount of teaching touch to go to the bathroom usually it's minimal amount and always you can let's say recheck at the end of the procedure and if you find that there is a significant amount of tissue then you can be moving at the end after example here is we're starting to doubt it's not kidding or not you have to be perfect but in case in case you think this plane is t2 do you have to correct you see just leave a little bit of tissue attached to the capsule and this way you can correct it's a plane that we point people and then we want you see that if you have seen other videos from
- this channel before we always follow the same strategy here I'm trying to get my fiber to fire close to the aroma because now we are descending a little bit good standing so the idea is I don't want to go through here because I could go through the bladder sorry to the capsule of the prostate into reprieve vesicle space so I want that I want to keep you close to the anomalies following the path of the off of the plane and try to get in the bladder at 12 o'clock but of course carefully here we saw a small amount of fat and these facts many times comes with the vessels where the vessels
- when the reenter prostates they simply take a little fat tissue around them so it's not very scary like here it's not very scary to see a little bit of fat like that doesn't mean that we are outside not necessarily sometimes it's a flying that there's a big profession but I have to say that's right unusual if you are careful with your dissection and you follow let's say the cervical rules of this technique just work carefully work slowly and then if you are confused you know for example here we can see circular fibers but we can also see some it's about fibers we are confused on we won't dare to enter your grade of profiling and you think I think this is the latter neck but I'm not sure but you
- can do is you can go inside the prostatic urethra you look for the for the way inside the study do it see if we find it it should be here somewhere in there it looks like it to study Dimitra in there and then you can do a 12 o'clock incision to connect with that side but most of the times and you see these metrical fibers you can just touch it on you'll see that you are inside the data alright so the case is progressing very fast across the small prostitute in take more than 12 or 15 minutes to communicate and as I said before that's not the goal of this depression or we're
- not with any rates will get traffic flow rates hit me carefully talking perform a radical it sinking of the normal tissue that it's posting follow through to this patient in a most therefore and sit away at the patient but I also said before this is fast with me and even when you at safe always slowly and carefully very often you see that the surgical time is very short here we are under there the normal here we have the advantage of being at the bladder neck let's enter to see whether
- you always yeah let's go to the other side and try to dissect let's say this side but it's nicer let's say to you open the bladder neck you connect this lateral aspect with the bladder neck so you can see exactly where it is and then [ __ ] the posterior plane it's much easier yeah coming up following the okay try to connect the unclear we are sometimes you see the plane in this case a small poster it's not clearly the time you're not so sure where it is but I'm following a certain tension line attack and then coming towards the latter neck
- is going to tell me giving more information about all the plane should go and ascending and at the same time I'm coming a little bit me do try to bring this last under section and connect it with the too bad just the plane is not so perfect this might be a normal tissue but maybe also if we go too deep we might get into trouble so if you are in doubt you can check wait awfully see there is more more I'm not stupid enough we should take off which which sorry I take off and it seems that it's a little bit of tissue there that
- we could be removing the thing we're making the cuffs all look very thin down there so we have to be careful so that might be a normal but it might also be lets say prostate claps no it's it's it's not so not so much issue it's just millimetric sides slope at the moment i think we are going to follow the previous then you see the yellow tissue sometimes it's vph teaching the white of tissue I think it's more personal so unless it's me a very very big not alone then I would be very aggressive trying to take it out you see what's to be a little bit of EPA to issue maybe a small nodule nothing really
- so there we are coming up coming up on around the epics let's see if we can bring this to connect with the latter neck sample here we have a very nice connection going to pop up I'm going to try to get a lil bit under your Noma and see if we can go from this side what's the other side if you find the right like laying like actually I see if you're working more or less in the same kind of debt for one accosting so the difficulty of doing this very small glance lies on the firefox the plane is not properly developed so there is no
- sometimes you have to operate without the normal on Tony Hawk news we are I think we are nearly any finishing the number here to keep your fiber very close to the adenoma because we need at we don't attach the enormous on the plane without forcing a lot of depth you know in the incisions on the on the plane and then of course we can try to flip we had no money to the ladder in this side of course you see that's that's you see that's little bits deepali could be also as I said the entry of the vessels into the bladder neck carrying some hot with them not
- scary at all you don't have to worry about that but you just recognize it and here we are already this is also bladder you think so we are already entering the lava that's on the course at the end connecting the incision we did before the perseverance nearly finishing our see that this abnormal have already flipped into the ladder you really clipped that's bladder neck see here you continue using a wrong plane you can get ready for any corporation so we have to judge you know where is the limit we
- want to take as reference for this steps of the operation well we are but that's the quick nucleation of the adenoma this is a filter we get the sinker Fuji safe and now we will go to the modulation face that's a little bit retro technology very much like when you do to you RP sometimes there is some tissue and as I said before you think there is some residual tissue you should take also then you can do it at the end so I think it's better to do a proper
- mutation where we don't risk for trading with actual having to return at the end to do some trimming of little bits and pieces that you think could have to to go with your normal this is also an opportunity to check the kind of status which is nearly perfect with the mostess technology let's mortal eight no no esta finished