Prostate operations become safer and painless with more accurate, powerful device.

Amodern type of laser designed for prostate surgery has been used in New Zealand for the first time, years after the technique was pioneered here.

Auckland surgeon Dr Chris Hawke, of Greenlight Urology, last week became the first specialist to use a thulium laser in New Zealand for a prostatectomy - surgery to remove part or all of the prostate gland.

Several thousand Kiwi men a year have prostatectomies, most commonly for benign prostatic hyperplasia (BPH), or enlargement of the prostate - a common condition that interferes with urine flow.

The modern laser prostatectomy was pioneered in Tauranga in the 1990s, when Associate Professor Peter Gilling and colleagues developed the holmium laser to treat enlarged prostates.


The ground-breaking procedure enabled specialists to resect the obstructing tissue in a safe, sterile and minimally invasive way, and holmium lasers are today used around the world.

Howick man Athol Birchenough, who had the surgery last week, was impressed by the technology and said the process was far easier than the last prostatectomy he had.

"There's no pain, there's nothing," the 69-year-old told the Herald.

Dr Hawke said it was significant for Kiwi science that the thulium laser, developed after the holmium laser, could now also be used here.

"It's become relatively common in the US and Europe, and there are also a few machines in Australia."

Dr Hawke said thulium laser surgery was more accurate and powerful, likening the upgrade from his former holmium laser to switching from analogue TV to digital.

"It's much like the holmium machine, but this beam is continuous, while the old one would cut in a ragged fashion," he said. "It vapourises the tissue a lot more effectively, and you don't have to spend much time retrieving prostate tissue from the bladder at the end of the operation."

The laser was also safe to fire within the bladder, as its beam was highly absorbed in water and its fibre had to be within a millimetre of the tissue surface to have any effect.

"Thulium laser will cut prostatic tissue with minimal bleeding like holmium, but at power ratings up to 200 watts - 50,000 times more powerful than a laser pointer. Because thulium is a lot more powerful than the holmium laser, the tissue can be more efficiently vapourised."

And while the holmium laser was primarily designed for breaking kidney stones, the thulium laser was engineered specifically for tissue applications, and could be used in other forms of surgery, such as liver, kidney and ear, nose and throat.

Despite laser technology, Dr Hawke said, the traditional procedure for prostatectomies, transurethral resection of the prostate, remained the most common in New Zealand.

This procedure, used since the 1960s, involved inserting through the urethra an instrument called a resectoscope, which contained an electrical loop that could cut tissue and seal blood vessels.

How it works
In a prostatectomy a quartz fibre is pushed through a small telescope, through the urethra to reach excess prostate tissue preventing urine flow. A laser passed through the fibre is used to remove the tissue, cutting it in a safe and minimally invasive way. Holmium lasers are already used in New Zealand for this surgery, but a thulium laser, more powerful and designed specifically for tissue application, is to be used here for the first time.