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Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (Ho LEP )
Author(s) -
Robert Grégoire,
Cornu JeanNicolas,
Fourmarier Marc,
Saussine Christian,
Descazeaud Aurélien,
Azzouzi AbdelRahmène,
Vicaut Eric,
Lukacs Bertrand
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13124
Subject(s) - enucleation , medicine , prostate , prospective cohort study , transurethral resection of the prostate , prostatectomy , surgery , urology , cancer
Objectives To describe the step‐by‐step learning curve of the holmium laser enucleation of the prostate (Ho LEP ) surgical technique. Subjects/patients and methods A prospective, multicentre observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy but never having performed Ho LEP . The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation within <90 min, without any conversion to standard transurethral resection of the prostate ( TURP ), with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. Results Of nine centres, three abandoned Ho LEP before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful Ho LEP procedures. Overall, the procedures were successfully performed in 43.6% of cases. Reasons for unsuccessful procedures were mainly operative time >90 min ( n = 51), followed by conversion to TURP ( n = 14), incomplete morcellation ( n = 8), significant stress ( n = 9), or difficulty ( n = 14) during Ho LEP . Ignoring operating time, 64% of procedures were successful and four out of five centres did four consecutive successful cases. Of the five centres that completed the study, four chose to continue Ho LEP . Conclusion Even in a prospective training structure, Ho LEP has a steep learning curve exceeding 20 cases, with almost half of our centres choosing to abandon or not to continue with the technique. Operating time and difficulty of the enucleation seem the most important problems for a beginner. A more intensely mentored and structured mentorship programme might allow safer adoption of the procedure.