Comparative study of laser technologies in endoscopic enucleation of the prostate: noise impact and surgical implications.

PURPOSE: To objectively assess and compare intraoperative noise levels generated by four different laser technologies used in endoscopic enucleation of the prostate (EEP) and evaluate their perceived impact on the operating room (OR) staff. METHODS: In this prospective study, 20 laser (EEP) procedures were indifferently assigned to four laser systems according to their availability in the OR: Holmium: YAG (Ho: YAG), Holmium Moses, Pulsed Thulium: YAG, and Thulium Fiber Laser (TFL). Noise levels were recorded using a calibrated sound level meter at six intraoperative time points, from standby to 20 min into the procedure. OR staff independently rated noise perception and related discomfort on validated Likert scales. RESULTS: TFL consistently produced the lowest noise levels throughout the procedure (61.1 ± 1.4 dBA at 10 min) compared to Ho: YAG (67.7 ± 3.7 dBA), Holmium Moses (65.2 ± 1.1 dBA), and Pulsed Thulium: YAG (64.3 ± 1.6 dBA) (p < 0.05). Corrected for background noise, TFL was up to 6.5 times quieter than Ho: YAG after 20 min. OR staff perceived significantly lower auditory disturbance with TFL, while nurses reported greater noise-related fatigue and communication difficulties than surgeons overall. CONCLUSION: Although none of the laser systems exceeded occupational noise safety thresholds (85 dBA), differences in intraoperative sound levels were clinically meaningful. TFL technology was associated with significantly reduced noise exposure and perceived OR disruption, supporting its value in improving surgical working conditions.