Fig. 1.

An image of a transurethral endoscope (Storz, Inc. 27292 AMA) with a HoLEP laser fiber introduced through the working channel. In a HoLEP procedure, the surgeon grasps a similar endoscope outside the patient, passes it transurethrally to the prostate, and manually adjusts endoscope pose to attempt to simultaneously control endoscope view, bring the laser to bear on the desired target, and manipulate soft tissue with the endoscope tip. The challenge of accomplishing all three tasks simultaneously is generally agreed to be the reason HoLEP can currently only be offered by a few of the most skilled physicians, despite proven clinical benefits for the patient.