Last year, Mayumana Healthcare succesfully installed a MultiPulse HoPLUS high power holmium laser from the manufacturer JenaSurgical in Gelre Ziekenhuizen, Apeldoorn. Unfortunately, COVID-19 delayed several surgeries, leaving the laser unused in the hospital for a long time. Luckily, this is gradually changing, since the country seems to be gaining more and more control over the pandemic. We spoke with treating urologist Michiel Arnolds about his experience with the laser and his decision for the HoLEP procedure.
Doctor Arnolds: ‘I have chosen for the HoLEP procedure because I believe in the concept of the treatment where you remove the entire prostatic adenoma. Instead of a TURP, where tissue sometimes partly remains, especially when treating a larger prostate. I believe in the principle that you use the natural planes and thus get it open very nicely. Besides, we would sometimes still do an open operation on the large prostates; like the Millin or the Hryntschak. Nowadays, when the possibilities are there, I prefer to switch to a minimally invasive procedure. We notice that patients are better orientated in the treatment options and therefore also ask about the option for a HoLEP procedure. The switch from open to minimally invasive was the real trigger.’
Doctor Arnolds has not really considered other techniques for treating the prostate. During his training he came into contact with other techniques, but by talking about them with various colleagues and then looking into them himself, his interest in the HoLEP procedure was quickly aroused. For example, he indicates that ‘various colleagues strongly believe in it and even think that this procedure is the future.’
Nevertheless, doctor Arnolds did find the choice for a specific laser, such as the MultiPulse HoPLUS, a difficult process. ‘That’s why I asked people: “Do you like the laser?” and “Why did you choose it?”. And that’s how I ended up with Michael Kortleve. At first the discussions were mainly about wattage; the higher the better, but one comes back to that now. Because of the contact with Mayumana Healthcare, I then went to see doctor Kortleve and talked to him about his experience with the laser and what he encountered. See, there are more good lasers on the market. Michael convinced me by indicating that the guidance would ensure that I could perform exactly the same procedure. By this I mean not only the guidance by Kortleve himself, but also the service of the supplier. I then asked Michael: “Have you ever had any problems?” and if so, “What was the solution?” or “Does the supplier no longer respond?”. That you are let with no laser at all for a longer period of time or something like that. Ultimately, the feeling of collaboration with Mayumana Healthcare was the decisive factor for me.’
The fact that the MultiPulse HoPLUS laser comes with a built-in morcellator was not a necessity for doctor Arnolds. With all available morcellators on the market, he started asking around again about the experiences of colleagues in order to make a conscious choice in this respect. ‘In the end, I don’t really care that it is in one device, but it is of course useful that you don’t have to add another device,’ responded doctor Arnolds.
In the meantime, doctor Arnolds has personally performed more than 20 procedures and some other various treatments with doctor Kortleve at his side. About the entire process up to the purchase of the laser and the training of the staff, doctor Arnolds says the following: ‘I experienced the process as very pleasant. It felt informative and educational, rather than commercial and only wanting to sell, and I really liked that. I didn’t get the feeling of “They must sell the laser”, but more like “We’re going to introduce the HoLEP procedure here”. I thought that was a big plus compared to how I experience this at other suppliers. We really did it together, step by step. Together we decided and planned how often we would go to see doctor Kortleve and how often he would come to us. We also organized separate training moments for the nurses to familiarize themselves with the process. The guidance is in principle on demand, Mayumana Healthcare is actually always there. So I have not felt unsafe in that sense, even though it is a new and technically difficult procedure. It has been a very pleasant process! Kortleve’s role in this is also great, you can get him in the OR quickly and he has no problems with me joining him in his OR. He thinks about the next steps in the procedure in order to keep working schematically according to plan. This is a great help to master and complete the HoLEP procedure.’