Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP)

Objectives To describe the step‐by‐step learning curve of the holmium laser enucleation of the prostate (HoLEP) surgical technique. Subjects/patients and methods A prospective, multicentre observational study was conducted, involving surgeons experienced in transurethral resection of the prostate an...

Full description

Saved in:
Bibliographic Details
Published in:BJU international 2016-03, Vol.117 (3), p.495-499
Main Authors: Robert, Grégoire, Cornu, Jean‐Nicolas, Fourmarier, Marc, Saussine, Christian, Descazeaud, Aurélien, Azzouzi, Abdel‐Rahmène, Vicaut, Eric, Lukacs, Bertrand
Format: Article
Language:English
Subjects:
Adult
Aged
Education, Medical, Continuing
enucleation
HoLEP
holmium
Humans
Laser Therapy
Lasers, Solid-State
Learning Curve
Male
Middle Aged
Operative Time
Prospective Studies
prospective study
prostate
Prostatic Diseases - surgery
Transurethral Resection of Prostate - education
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objectives To describe the step‐by‐step learning curve of the holmium laser enucleation of the prostate (HoLEP) surgical technique. Subjects/patients and methods A prospective, multicentre observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy but never having performed HoLEP. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation within 90 min (n = 51), followed by conversion to TURP (n = 14), incomplete morcellation (n = 8), significant stress (n = 9), or difficulty (n = 14) during HoLEP. Ignoring operating time, 64% of procedures were successful and four out of five centres did four consecutive successful cases. Of the five centres that completed the study, four chose to continue HoLEP. Conclusion Even in a prospective training structure, HoLEP has a steep learning curve exceeding 20 cases, with almost half of our centres choosing to abandon or not to continue with the technique. Operating time and difficulty of the enucleation seem the most important problems for a beginner. A more intensely mentored and structured mentorship programme might allow safer adoption of the procedure.
ISSN:1464-4096
1464-410X
DOI:10.1111/bju.13124