Comparison of Modified Single Incision Two Loop Technique and Classical Three Lobe Technique in HoLEP: Experience of 200 Cases of a Single Surgeon

Abstract

Introduction: We aimed to present our single incision two-lobe technique, which we developed in our own clinic and performed by a single surgeon and to compare the results of this technique with the results of Gilling's 3-lobe technique, which we applied before.
 Material Method: HOLEP was performed in 200 patients with medically resistant lower urinary tract symptoms (LUTS) and BPH, regardless of prostate size, between December 2018 and August 2022 in our urology clinic. All operations in the study were performed by a single surgeon who had completed the HoLEP learning curve, was well versed in endoscopic surgery, and had high experience. The classical Gilling 3-lobe method was preferred in the first hundred cases after the cases in the first fifty cases learning curve (Group 1, n=100). Due to some difficulties in the technique after the experience in the first hundred cases, the single incision two-lobe technique, which was created by referencing and modifying Scoffone's en bloc no touch technique, was used in the next hundred cases (Group 2, n=100).
 Results: The average age of a total of 54 patients who underwent surgery due to a retroperitoneal mass was 53.8±10.0 years. While 15 (27.8%) of 54 patients with a retroperitoneal mass were diagnosed incidentally, 39 (72.2%) patients were diagnosed symptomatically. The final pathological outcome of all relapsed patients was liposarcoma. The average operation time was 178.7±85.4 minutes. The average length of stay of the patients was 6.2±3.1 days. Additionally, all of these patients had organ resection. In the Kaplan-Meier survival analysis, it was found that surgical margin had a statistically significant effect on average survival (p