2166 EVOLUTION OF THE LEARNING CURVE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) - A SINGLE CENTRE EXPERIENCE OF THE FIRST 458 CASES IN THE UNITED KINGDOM

Autor: Sashi S. Kommu, Zakarian Artaches, Rick Popert
Rok vydání: 2013
Předmět:
Zdroj: Journal of Urology. 189
ISSN: 1527-3792
0022-5347
Popis: INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) is the only laser treatment for BPH with level 1 evidence and endorsement in both the American Urological Association (AUA) and European Association of Urology (EAU) guidelines. The learning curve for skill acquisition of HoLEP has been ill understood thus far. Herein, we aim to report the evolution of the learning curve in the skill acquisition for HoLEP in a single tertiary referral centre in the United Kingdom. METHODS: Four hundred and fifty eight (n 458) consecutive patients who underwent HoLEP from Jan 2003 to September 2012 by a single surgeon were studied. Perioperative clinical variables, including enucleation time, morcellation time, enucleation efficacy (enucleated weight/enucleation time) and early complication rate were analyzed. The patterns in skill acquisition as the technique evolved were studied. RESULTS: Mean prostate volume was 44cc(8?367cc). Parameters for two lobe versus three lobe resections were respectively (a)lasing time 39.1 vs. 41.3min(P 0.70); extraction time 12.0 vs. 13.5min(P 0.82); operative time 56.0 vs. 59 min(P 0.78); eneucleated tissue 20g vs. 26g(P 0.41); wt/laser time 0.47 g/min vs. 0.6 g/min(P 0.32) and catheter removal 2.0 days vs. 2.2 days(P 0.98). Pre and postop IPSS was 25 and 6 for the two lobe vs. 23 and 9 for the three lobe resection(P 0.97). Pre and postop Qmax was 8 and 21 for the two lobe vs. 8 and 20 for the three lobe resection(P 0.60). Median duration of postoperative indwelling catheter was 1(range 1-4) day and median hospital stay was 1(range 1-5)day. Mean morcellation time overall was 12 mins. There were 15/458(3.3%) early ( 5days post op) surgery-related complications overall. There were 19/295(6.4%) complications at 48 months follow-up.With increasing experience larger prostates were undertaken. However, there was no correlation in complication rates by year of cumulative experience of the surgeon. There was an increasing trend of enucleation efficacy as the number of cases completed increased. The plateau of enucleation ratio efficacy was reached at the twentieth case. As the technique evolved in parallel with the number of cases done, three lobe resections were undertaken. CONCLUSIONS: Our results demonstrate that HoLEP is a safe and effective means for treating BPH. The operative learning curve plateau was reached after the first 20 cases. A step wise cumulative approach can aid in safe and optimal skill acquisition by progressing from two lobe to a three (“complete HoLEP”) lobe eneucleation.
Databáze: OpenAIRE
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