MP27-07 CAN WE PREDICT THE LEARNING CURVE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) BY USING SIMULTANEOUS PARAMETER OF ENUCLEATION-MORCELLATION?

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2017MP27-07 CAN WE PREDICT THE LEARNING CURVE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) BY USING SIMULTANEOUS PARAMETER OF ENUCLEATION-MORCELLATION? Sung Tae Cho, Don Kyoung Choi, Ohseong Kwon, Young Goo Lee, Ki Kyung Kim, and Kyungtae Ko Sung Tae ChoSung Tae Cho More articles by this author , Don Kyoung ChoiDon Kyoung Choi More articles by this author , Ohseong KwonOhseong Kwon More articles by this author , Young Goo LeeYoung Goo Lee More articles by this author , Ki Kyung KimKi Kyung Kim More articles by this author , and Kyungtae KoKyungtae Ko More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.799AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive laser therapy for benign prostatic hyperplasia. However, a steep operative learning curve may be the main drawback to use of HoLEP. The enucleation ratio or efficacy were known as one of the parameters for estimating the learning curve. But this parameter is only focused on time of enucleation not considering morcellation, even though operators spend time of enucleation and morcellation simultaneously during HoLEP surgery. The aim of this study was to evaluate a various method to assess the learning curve of HoLEP of a single surgeon. METHODS Ninety-two consecutive cases performed by the single surgeon were enrolled. Intraoperative measures, including enucleation time, enucleation ratio (enucleated weight/transitional zone volume), enucleation efficacy (enucleated weight / enucleation time), consumed energy, morcellation time, morcellation efficacy (enucleated weight / morcellation time) and enucleation-morcellation efficacy (enucleated weight/enucleation and morcellation time) were analyzed. Perioperative morbidity, length of hospital stay and length of urinary drainage were also investigated. In addition, functional outcomes such as Qmax, post-void residual volume, IPSS and QoL scores at 3 and 6months were also investigated. RESULTS The mean age of the patients was 72.9 years (49-86) with a mean prostate volume of 59.2 cc (34-180) on transrectal ultrasonography. Within all procedures, mean total operative time was 86.5 minutes (45-260 minutes) with a mean enucleated weight of 42.2 g (25-120 g). Mean enucleation time, consumed energy, morcellation time and enucleation ratio were 48.9 ± 12.1 min, 67.5 ± 22.8 kJ, 22.4 ± 14.5 min and 0.64 ± 0.32 g/mL, respectively. In terms of efficiency, enucleation efficacy, morcellation efficacy and enucleation-morcellation efficacy were 0.42 ± 0.37 g/min, 4.24 ± 1.26 g/min and 0.24 ± 0.11 g/min, respectively. Perioperative complications were observed in 12 of 92 (13.0%). Of these, 10 were urinary tract infection and 2 was urethral stricture. Considering the learning curve, the plateau of enucleation efficacy was reached after 38 cases. However, considering enucleation and morcellation time simultaneously, enucleation-morcellation efficacy has an increasing trend even after 38 cases and has remained roughly constant after 55 cases. Based on these criteria, we divided cases into two groups. Enucleation efficiency was significantly higher after 38 cases. Morcellation efficiency was also higher in the second group, however, the difference was not significant. Enucleation-morcellation efficiency was significantly higher after 55 cases. Perioperative morbidities, hospital length of stay, urinary drainage length and functional outcomes at 3 and 6months were not significantly different between the groups based on these criteria. CONCLUSIONS Although the learning curve did not interfere with functional results, our results demonstrated that even after 38 cases, surgical skill advances are still needed. Of these factors, morcellation time is as important as enucleation time in the whole surgical procedure. Enucleation-morcellation efficacy might be considered a better parameter for estimating the operative learning curve of HoLEP rather than enucleation efficacy alone. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e331 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sung Tae Cho More articles by this author Don Kyoung Choi More articles by this author Ohseong Kwon More articles by this author Young Goo Lee More articles by this author Ki Kyung Kim More articles by this author Kyungtae Ko More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...