Step 2 Access to the plane F. Gomez Sancha

The capsular localization maneuver is carried out on the right side, and mechanical enucleation is carried out using the tip of the scope to develop the virtual space between surgical capsule and adenoma, alternating gentle dissection maneuvers with coagulation at low power of any capsular bleeding. Of note, the recognition of the capsular plane is easier than with holmium laser as the capsule is not affected by mechanical pulse energy, and thus, the anatomy is more recognizable. 

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The sphincter is progressively dissected off the apex of the prostate from 6 toward 12 o’clock on one side (Pictures 3, 4). 

Figure: procedure-steps