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

Abstract：

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, without any conversion to standard transurethral resection of the prostate (TURP), with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. RESULTS:Of nine centres, three abandoned HoLEP before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful HoLEP procedures. Overall, the procedures were successfully performed in 43.6% of cases. Reasons for unsuccessful procedures were mainly operative time >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.

journal_name

BJU Int

journal_title

BJU international

authors

Robert G,Cornu JN,Fourmarier M,Saussine C,Descazeaud A,Azzouzi AR,Vicaut E,Lukacs B

doi

10.1111/bju.13124

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

495-9

issue

eissn

1464-4096

issn

1464-410X

journal_volume

117

pub_type

杂志文章,多中心研究

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