Prospective Evaluation of the Learning Curve for Holmium Laser Enucleation of the Prostate

Abstract

An endourologist inexperienced with holmium laser prostate enucleation can perform the procedure with reasonable efficiency after about 50 cases with an outcome comparable to that of experts, as described in the literature. During the learning curve conversion to transurethral prostate resection can be done without any harm to the patient.

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

“…We found that reports based on subjective experience or confidence concluded that HoLEP competency required 20-30 cases of experience (6,11). On the other hand, reports based on enucleation efficacy concluded that at least 50 cases were needed to attain competency (12,13). Enucleation efficacy is considered to be a more objective parameter to estimate operative learning curve.…”

“…Some researchers have argued that a surgeon needs between 20 and 30 cases of experience to attain competency (6,11), while others have argued that up to 50 cases are needed (12,13). This discrepancy comes mainly from the absence of an accurate way to evaluate the operative learning curve.…”

Holmium Laser Enucleation of the Prostate: Modified Technical Aspects

“…An average of 15-20 cases is needed for the trainee to feel confident with the technique [13]. However, others have reported that an endourologist inexperienced with HoLEP can perform the procedure with reasonable efficiency after about 50 cases, with an outcome comparable to that of the experts [14]. We feel that it is also important that learning the technique is easier if cases follow closely after each other to avoid relearning for every case.…”

Photoselective vaporization of the prostate (GreenLight PV): lessons learnt after 3500 procedures

“…It has been recommended that a minimum of 50 procedures on smaller (o50 ml) prostate should be performed before larger prostate enucleations are attempted. 3 Photoselective vaporization of the prostate (PVP) using the 80-W potassium-titanyl-phosphate (KTP) laser was first reported in 2003 in a pilot study involving men with prostates sized 24-76 ml with good outcome and minimal morbidity. 4 The unique 532 nm wavelength that the laser operates at is highly absorbed by oxyhaemoglobin and minimally absorbed by water.…”