How to cite: Bechis SK. BPH Procedures, Tips & Trips: GreenLight™ PVP. Grand Rounds in Urology. November 13. Accessed Feb 2026. https://grandroundsinurology.com/bph-procedures-tips-tricks-greenlight-pvp/
Summary
Seth K. Bechis, MD, MS, Associate Professor of Urology, University of California, San Diego, San Diego, California, provides a focused, technical walkthrough of GreenLight™ photoselective vaporization (PVP) of the prostate, emphasizing practical tips that improve efficiency, visualization, and durability of symptom relief. Dr. Bechis demonstrates a systematic approach to vaporization that prioritizes landmark identification, depth control, and hemostasis while minimizing postoperative symptoms.
Dr. Bechis positions GreenLight™ PVP as an ablative, non–minimally invasive surgical option for benign prostatic hyperplasia. Dr. Bechis stresses that success with PVP depends on disciplined technique rather than speed. The foundational step is identifying key anatomic landmarks, including the ureteral orifices, the trigone, the median lobe, and the verumontanum. These landmarks define safe boundaries and guide the depth of vaporization.
A core technical concept is the creation of working channels at the 5 and 7 o’clock positions using low-power settings around 80 watts. These channels define the surgical capsule and reveal median lobe anatomy, allowing the surgeon to establish consistent depth before increasing power. Once depth is defined, laser power is increased to approximately 180 watts to optimize vaporization efficiency.
Dr. Bechis emphasizes visual cues to confirm adequate tissue removal. Shiny, pearly white tissue indicates proximity to the capsule, while darker, charred tissue represents residual adenoma. Large “scuba-like” bubbles signal effective vaporization, whereas small “champagne” bubbles suggest insufficient energy delivery or excessive distance from tissue. Distance to tissue, sweep speed, and sweep arc are highlighted as adjustable variables that determine vaporization quality.
Vaporization is performed systematically, strip by strip, rather than roaming between areas. Median lobe tissue is addressed first when present, followed by lateral lobes and anterior tissue if significant. Bleeding control is achieved using the coagulation setting, often by painting around a bleeding vessel rather than targeting the cut surface directly. The presentation concludes with the “lighthouse” technique, in which circumferential coagulation is performed at the end of the case to seal surfaces, particularly in anticoagulated or highly vascular patients.
In this presentation, Dr. Bechis provides actionable guidance for surgeons seeking to refine the GreenLight™ PVP technique and improve outcomes.
About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Seth K. Bechis, MD, MS, is an Associate Professor of Urology at the University of California, San Diego, San Diego, California. Dr. Bechis specializes in all procedures of the prostate, including minimally invasive procedures such as Rezum water vapor therapy and UroLift, as well as robotic surgery and GreenLight Laser photoselective vaporization of the prostate. His current research focuses on improving surgical techniques and clinical outcomes in stone disease, as well as tools for stone diagnosis and opiate-sparing pathways for managing pain.
Dr. Bechis earned his Masters of Science in Biomedical Sciences and his medical degree from the University of California, San Francisco. He completed his residency at Harvard University in Boston, Massachusetts. Dr. Bechis then completed a fellowship in Laparoscopy/Robotics and Endourology at the University of California, San Francisco, San Francisco, California.
Dr. Bechis is a member of several professional medical organizations, including the American Urological Association (AUA), the Endourological Society, and the Western Section of the AUA. He has won numerous awards and honors over the years, including the Whitehill Award for Excellence in Clinical Teaching in 2019, Plenary Address for Best Abstract from the AUA in 2015, and first place in the 2014 Max K. Willscher Resident Research Award Competition. Dr. Bechis has been invited to speak nationally and internationally at conferences on topics including benign prostatic hyperplasia and stone disease. His research has been featured in peer-reviewed medical journals, including Journal of Urology, Journal of Endourology, and World Journal of Urology. Additionally, Dr. Bechis was editor of First Aid Q&A for the USMLE Step 1, Second Edition, and has authored chapters for university handbooks.
