Learning From Those who Learned: A Survey of Fellowship Trained HoLEP Surgeons and Their Current Practice Patterns

Wright, Harlan I.; Fedrigon, Donald; De, Smita

doi:10.1016/j.urology.2020.12.023

Cited by 10 publications

(4 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…AEEP is recognised as a more technically challenging procedure compared to alternatives such as transurethral resection of the prostate (TURP). To this end, European guidelines outline that it is surgeon experience that has the largest impact on complications and mentorship programmes are recommended accordingly [ 1 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

Juliebø-Jones,

Gauhar,

Castellani

et al. 2024

World J Urol

View full text Add to dashboard Cite

Purpose The primary aim of the study was to evaluate if en-bloc vs. non en-bloc made a difference to intra-, peri- and post-operative surgical outcomes of anatomical endoscopic enucleation (AEEP) in large (> 80 cc) and very large prostates (> 200 cc). The secondary aim was to determine the influence of energy and instruments used. Methods Data of patients with > 80 cc prostate who underwent surgery between 2019 and 2022 were obtained from 16 surgeons across 13 centres in 9 countries. Propensity score matching (PSM) was used to reduce confounding. Logistic regression was performed to evaluate factors associated with postoperative urinary incontinence (UI). Results 2512 patients were included with 991 patients undergoing en-bloc and 1521 patients undergoing non-en-bloc. PSM resulted in 481 patients in both groups. Total operation time was longer in the en-bloc group (p < 0.001), enucleation time was longer in the non en-bloc group (p < 0.001) but morcellation times were similar (p = 0.054). Overall, 30 day complication rate was higher in the non en-bloc group (16.4% vs. 11.4%; p = 0.032). Rate of late complications (> 30 days) was similar (2.3% vs. 2.5%; p > 0.99). There were no differences in rates of UI between the two groups. Multivariate analysis revealed that age, Qmax, pre-operative, post-void residual urine (PVRU) and total operative time were predictors of UI. Conclusions In experienced hands, AEEP in large prostates by the en-bloc technique yields a lower rate of complication and a slightly shorter operative time compared to the non en-bloc approach. However, it does not have an effect on rates of post-operative UI.

show abstract

Section: Discussionmentioning

confidence: 99%

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

Juliebø-Jones,

Gauhar,

Castellani

et al. 2024

World J Urol

View full text Add to dashboard Cite

show abstract

“…It is known that a surgeon becomes familiar with the technique after an initial 30 [ 19 ] to 50 cases of surgery [ 20 ]. Close mentorship is emphasized to overcome the learning curve [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Self-Training Using Virtual Reality Head-Mounted Display Simulator on the Acquisition of Holmium Laser Enucleation of the Prostate Surgical Skills

Jang,

Kong,

Baek

et al. 2024

Int Neurourol J

View full text Add to dashboard Cite

Purpose: We aimed to evaluate the effect of self-training using a virtual reality head-mounted display simulator on the acquisition of surgical skills for holmium laser enucleation surgery.Methods: Thirteen medical students without surgical skills for holmium laser enucleation of the prostate were trained using multimedia to learn the technique via simulator manipulation. Thereafter, participants performed the technique on a virtual benign prostatic hyperplasia model A (test A). After a 1-week wash-out period, they underwent self-training using a simulator and performed the technique on model B (test B). Subsequently, participants were asked to respond to Training Satisfaction Questions. Video footage of hand movements and endoscope view were recorded during tests A and B for later review by 2 expert surgeons. A 20-step Assessment Checklist, 6-domain Global Rating Scale, and a Pass Rating were used to compare performance on tests A and B.Results: Thirteen participants completed both tests A and B. The 20-step Assessment Checklist and 6-domain Global Rating Scale evaluation results showed significantly improved scores in test B than in test A (P<0.05). No evaluator rated participants as passed after test A, but 11 participants (84.6%) passed after test B. Ten participants (76.9%) indicated that the simulator was helpful in acquiring surgical skills for holmium laser enucleation of the prostate.Conclusions: The virtual reality head-mounted display holmium laser enucleation of the prostate simulator was effective for surgical skill training. This simulator may help to shorten the learning curve of this technique in real clinical practice in the future.

show abstract

“…Although there are many other motivations to learn HoLEP, its financial reimbursement cannot be ignored. In a recent survey of graduated endourology fellows, many cited that some of the most challenging aspects of HoLEP in their current practice were to ensure procedure efficiency to maintain profitability and poor reimbursement for the skill required [42 ▪ ].…”

Section: Rvus and Benign Prostatic Hyperplasia: Are We Disincentivizi...mentioning

confidence: 99%

Reimbursement of surgical procedures for benign prostatic hyperplasia: are we disincentivizing complex care?

Narang

Kellner²,

Krambeck

et al. 2022

Current Opinion in Urology

View full text Add to dashboard Cite

Purpose of reviewTo provide an overview of how surgical benign prostatic hyperplasia (BPH) procedures are compensated in the United States and the implications of the current reimbursement system on the care of patients.Recent findingsThe resource-based relative value care system is Medicare's current reimbursement model. There is strong evidence that the current system does not adequately account for complex care. Consequently, for BPH surgical procedures, treatment options best suited for complex patients are not adequately reimbursed which may have implications on healthcare delivery and outcomes.SummaryInadequate reimbursement for certain BPH procedures may disincentivize the care of complex patients. Procedures such a holmium laser enucleation of the prostate are well suited for complex patients but have a steep learning curve. The incentive to learn and offer such procedures to complex patients may be unfairly influenced by reimbursement levels, which in the end penalizes patients and the treatments available to them.

show abstract

Learning From Those who Learned: A Survey of Fellowship Trained HoLEP Surgeons and Their Current Practice Patterns

Cited by 10 publications

References 25 publications

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

Effect of Self-Training Using Virtual Reality Head-Mounted Display Simulator on the Acquisition of Holmium Laser Enucleation of the Prostate Surgical Skills

Reimbursement of surgical procedures for benign prostatic hyperplasia: are we disincentivizing complex care?

Contact Info

Product

Resources

About