A wide range of laser technologies have been developed for anatomical endoscopic enucleation of the prostate (AEEP), which adopts the principle of open prostatectomy. Recent advancements in technical aspects and surgical techniques have significantly enhanced its appeal as a surgical treatment option for benign prostatic obstruction. The safety and efficacy of AEEP have been widely demonstrated, regardless of the energy source utilized. This video aims to provide an overview and demonstrate our center’s experience performing AEEP using various energy sources.

From October 2017 to October 2023, we prospectively recorded all AEEP cases at our institution after obtaining informed patient consent. A total of 556 procedures were performed by a single surgeon (H.E.). The surgeon utilized various energy sources, including a 100-W Holmium:YAG laser (VersaPulse PowerSuite™, Lumenis, Yokneam, Israel), MOSESTM 1.0 and MOSES 2.0 pulse-modulation systems (Lumenis, Yokneam, Israel), 180-W GreenLight XPSTM laser system (Boston Scientific, Marlborough, MA) and Thulium Fiber Laser (SoltiveTM Premium, Olympus, USA). We extracted video clips of the different energy sources employed during AEEP from the original recordings.

We utilized various laser energy sources to achieve the maximal debulking of adenomas. Our experience demonstrates that the efficacy of AEEP depends on several factors, including a comprehensive understanding of laser-tissue interactions, including wavelength, absorption coefficient, peak power, working distance, and the surgeon's expertise. Undoubtedly, the most important feature of AEEP lies in the meticulous dissection of the anatomical plane while avoiding cutting through the adenoma.

AEEP using various energy sources and technologies can be safely added to urologists' armamentarium of benign prostatic obstruction treatments. Our findings demonstrate that the favorable outcomes achieved with AEEP can be attributed to the anatomical completeness of adenoma removal rather than the energy source utilized.