Due to the accelerating growth of aging population, the high BPH/LUTS prevalence has been a significant financial and medical burden to patients and society. In the domain of BPH surgery, the rate of TURP has been decreasing with an increase in minimally invasive surgical therapies (MISTs). Photoselective vaporization of the prostate (PVP), as a major laser surgery, was considered a safe and effective outpatient procedure due to several advantages including reduction of bleeding. Compared with PVP, HoLEP showed effectiveness at improving urinary parameters and associated with minimal postoperative discomfort .
On the other hand, the concern for the surgeons’ occupational health is rising. Occupational noise exposure is one of the main hazards and described according to European regulations in 2003. In these regulations, the occupational noise exposure should not exceed 87 dB and hearing protection was recommended above 85 dB. According to the standard set by the “Law of the People’s Republic of China on Prevention and Control Law of Occupational Diseases”, 8h of exposure to 85~90 dB is considered as slight harm to health. Long-term occupational noise exposure is considered to increase rates of noise-induced hearing loss. In terms of urologic operation, the evaluation of noise exposure during lithotripsy procedure has been studied . A maximum sound level of 83 dB with an average of 77 dB was recorded during SWL . It seemed that the risk of hearing loss caused by the devises with high decibel levels was low due to the relatively short duration. However, it was estimated that the risk of noise-induced hearing loss would increased to 35% for workers with a 40-year exposure to 85 dB per 8 hour-working a day . It was believed that the occupational noise exposure is an underestimated problem during the urologic procedures.
The noise produced by the laser machine was mainly from the cooling system. In our study, the relative high decibel level was recorded in the 100-W and 60-W holmium laser machine and the lowest average decibel was recorded in the 90-W holmium laser machine which is from a different manufacturer. The reasons for this difference lie in the theory of the refrigerator. The function of the compressor is to compress low temperatures and high pressures gas into high temperatures and high pressure gas, so that the steam volume is reduced and pressure is elevated, which is sent to condenser then. It condenses into low temperatures and high pressure liquid and throttled to be low temperatures and pressures liquid. The liquid is sent to evaporation and evaporated to be high temperature and low pressure gas. The cooling cycle is then completed when the gas is sent to the entrance of compressor. In the 90-W machine, the cooling system is modified. The evaporator is placed in the water tank and the water temperature can be dropped. The water is pumped and sent to the laser generator to take away the heat from xenon lamp. The effect of refrigeration is achieved by the hot and cold water exchange in the water tank. When this cooling system is not working, the main noise comes from pump. Noise comes from compressor and cooling fan when the system is working. Due to the low speed of fan, the noise will be controlled under relatively low decibel level. In the 100-W and 60-W laser system, when the water form pump comes into the laser generator, the working fan cool down the water temperature. The speed of fan should produce high rotation to take away the great heat, making a lot of noises at the same time.
The data also presented that the anxiety scores of surgeons who works with the 100-W HoLEP machine were higher than surgeons working with other laser machine, presenting that working in a noisy environment for an 8h working day directly make surgeons uncomfortable. Several studies showed the efficacy of music and noise –cancelling headphones during surgery would reduce unwanted ambient sounds and lower the anxiety and pain scores (VAS) [11, 14]. Thus, we believe that surgeons may benefit form the music therapy and headphones during the procedure.