The Learning Curve for Holmium Laser Enucleation of the Prostate: A Single-Center Experience
نویسندگان
چکیده
PURPOSE Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve and, as a result, its clinical usage has limitations. The purpose of this study was to analyze the learning curve and early complications following the HoLEP procedure. MATERIALS AND METHODS A retrospective analysis was performed on 161 patients who had undergone the HoLEP procedure for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) from July 2008 to September 2009. The procedure was done by two surgeons. Perioperatively, enucleated tissue weight, enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), and enucleation efficiency (enucleated weight/enucleation time) were analyzed, and early complications were assessed. RESULTS Mean enucleation time, morcellation time, and enucleation ratio were 61.3 min (range, 10-180 min), 12.3 min (range, 2-60 min), and 0.66 (range, 0.07-2.51), respectively. In terms of efficiency, enucleation efficiency was 0.32 g/min (range, 0.02-1.25 g/min) and morcellation efficiency was 1.73 g/min (range, 0.1-7.7 g/min). Concerning the learning curve, enucleation efficiency was stationary after 30 cases (p<0.001), morcellation efficiency reached a learning curve at 20 cases (p=0.032), and enucleation ratio had no learning curve in this study. There were several cases of surgery-related complications, including bladder mucosal injury by the morcellator (13%), capsular injury during enucleation (7%), and conversion to a conventional resectoscopy procedure (15%), which showed a reduction in incidence with time. CONCLUSIONS The learning curve of HoLEP is steep; however, it can be overcome gradually. Further study is necessary with respect to long-term postoperative follow-up.
منابع مشابه
Technical Aspects of Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia
Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very...
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Background: Holmium laser enucleation of the prostate (HoLEP) is a safe and effective therapeutic option in patients suffering from benign prostatic hyperplasia (BPH) of any size. In spite of its excellent and durable outcomes, HoLEP is gaining widespread acceptance very slowly, since it is perceived as requiring significant endoscopic skill and having a steep learning curve. Here we present ou...
متن کاملEditorial comment on: Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve.
OBJECTIVES To evaluate long-term outcomes and reoperation rate of holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic enlarged prostate, including patients who were operated during the learning curve. METHODS A retrospective analysis of 118 patients who underwent HoLEP between March 1998 and February 2001 at our institution. This analysis represented our initial ex...
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INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH). Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. The learning curve remains an obstacle, preventing more widespread adoption of this ...
متن کاملComparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons’ Experience During Learning Curve
PURPOSE To detect predictive factors for postoperative incontinence following holmium laser enucleation of the prostate (HoLEP) according to surgeon experience (beginner or experienced) and preoperative clinical data. METHODS Of 224 patients, a total of 203 with available data on incontinence were investigated. The potential predictive factors for post-HoLEP incontinence included clinical fac...
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عنوان ژورنال:
دوره 51 شماره
صفحات -
تاریخ انتشار 2010