The long-term learning curve of holmium laser enucleation of the prostate (HoLEP) in the en-bloc technique: a single surgeon series of 500 consecutive cases
Purpose To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases. - Methods Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
24 July 2024
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| In: |
World journal of urology
Year: 2024, Volume: 42, Issue: 1, Pages: 1-7 |
| ISSN: | 1433-8726 |
| DOI: | 10.1007/s00345-024-05097-9 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1007/s00345-024-05097-9 Verlag, kostenfrei, Volltext: https://link.springer.com/10.1007/s00345-024-05097-9 
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| Author Notes: | M.J. Wenk, F.O. Hartung, L. Egen, C. Netsch, M. Kosiba, B. Grüne, Jonas Herrmann |
| Summary: | Purpose To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases. - Methods Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1-5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test. - Results Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1). - Conclusions HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time. |
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| Item Description: | Gesehen am 12.12.2024 |
| Physical Description: | Online Resource |
| ISSN: | 1433-8726 |
| DOI: | 10.1007/s00345-024-05097-9 |