PMID- 35822547
OWN - NLM
STAT- MEDLINE
DCOM- 20221109
LR  - 20221122
IS  - 1557-900X (Electronic)
IS  - 0892-7790 (Linking)
VI  - 36
IP  - 11
DP  - 2022 Nov
TI  - Switching Lasers: Learning Curve of Holmium Laser Enucleation of the Prostate in 
      Surgeons Experienced in Thulium Laser Enucleation of the Prostate.
PG  - 1444-1451
LID - 10.1089/end.2022.0262 [doi]
AB  - Objective: To evaluate perioperative parameters, clinical outcomes, and the 
      learning curve of holmium laser enucleation of the prostate (HoLEP) in surgeons 
      with experience in thulium laser enucleation of the prostate (ThuLEP). Materials 
      and Methods: The learning curves for HoLEP of the first 50 consecutive patients 
      of two surgeons experienced in ThuLEP were analyzed. In addition, demographic 
      parameters, clinical outcomes, and adverse events (AEs) were evaluated. Results: 
      Mean operation time was 70.9 +/- 29.7 minutes (standard deviation) (Surgeon 1) and 
      74.4 +/- 35.4 minutes (Surgeon 2), the mean enucleation efficiency was 
      1.5 +/- 0.6 g/min (Surgeon 1) and 1.5 +/- 0.7 g/min (Surgeon 2). The hemoglobin loss 
      was 0.9 +/- 0.8 and 0.8 +/- 0.8 g/dL. For both surgeons, there was a significant 
      learning curve in enucleation efficiency within the first 50 cases (Surgeon 1: 
      p = 0.034, Surgeon 2: p = 0.006, both: p = 0.0003, Spearman's rho = 0.351). Both 
      surgeons started with an enucleation efficiency of around 1 g/min in their first 
      10 cases. No significant correlation between hemoglobin loss and experience could 
      be found (p = 0.823, rho = 0.025). While there was no significant learning curve 
      for morcellation efficiency (p = 0.785, rho = 0.028), a significant progress was 
      found for one of the two surgeons regarding laser energy efficiency (p = 0.014). 
      The overall incidence of all grade treatment-related AEs was low at 10.0%, and 
      extremely low for significant complications with Clavien-Dindo Grade >II at 1%. 
      Conclusions: In our analysis, switching to HoLEP is uncomplicated and safe for 
      experienced ThuLEP surgeons. The enucleation efficiency was high from the 
      beginning, but a learning curve was present for both surgeons. No learning curve 
      was noticeable in hemoglobin loss and the incidence of complications, both of 
      which were low throughout the study.
FAU - Himmler, Maren
AU  - Himmler M
AUID- ORCID: 0000-0001-8816-0786
AD  - Department of Urology and Urological Surgery, University Medical Center Mannheim, 
      University of Heidelberg, Mannheim, Germany.
FAU - Grune, Britta
AU  - Grune B
AD  - Department of Urology and Urological Surgery, University Medical Center Mannheim, 
      University of Heidelberg, Mannheim, Germany.
FAU - von Hardenberg, Jost
AU  - von Hardenberg J
AD  - Department of Urology and Urological Surgery, University Medical Center Mannheim, 
      University of Heidelberg, Mannheim, Germany.
FAU - Hartung, Friedrich Otto
AU  - Hartung FO
AD  - Department of Urology and Urological Surgery, University Medical Center Mannheim, 
      University of Heidelberg, Mannheim, Germany.
FAU - Kowalewski, Karl-Friedrich
AU  - Kowalewski KF
AD  - Department of Urology and Urological Surgery, University Medical Center Mannheim, 
      University of Heidelberg, Mannheim, Germany.
FAU - Rassweiler-Seyfried, Marie-Claire
AU  - Rassweiler-Seyfried MC
AD  - Department of Urology and Urological Surgery, University Medical Center Mannheim, 
      University of Heidelberg, Mannheim, Germany.
FAU - Michel, Maurice Stephan
AU  - Michel MS
AD  - Department of Urology and Urological Surgery, University Medical Center Mannheim, 
      University of Heidelberg, Mannheim, Germany.
FAU - Herrmann, Jonas
AU  - Herrmann J
AD  - Department of Urology and Urological Surgery, University Medical Center Mannheim, 
      University of Heidelberg, Mannheim, Germany.
LA  - eng
PT  - Journal Article
DEP - 20220809
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
RN  - 8RKC5ATI4P (Thulium)
RN  - W1XX32SQN1 (Holmium)
SB  - IM
MH  - Male
MH  - Humans
MH  - Thulium
MH  - *Lasers, Solid-State/therapeutic use
MH  - Prostate
MH  - *Prostatic Hyperplasia/surgery
MH  - *Laser Therapy
MH  - Holmium
MH  - *Surgeons
MH  - Treatment Outcome
MH  - Retrospective Studies
OTO - NOTNLM
OT  - HoLEP
OT  - ThuLEP
OT  - learning curve
OT  - prostatic hyperplasia
EDAT- 2022/07/14 06:00
MHDA- 2022/11/10 06:00
CRDT- 2022/07/13 06:12
PHST- 2022/07/14 06:00 [pubmed]
PHST- 2022/11/10 06:00 [medline]
PHST- 2022/07/13 06:12 [entrez]
AID - 10.1089/end.2022.0262 [doi]
PST - ppublish
SO  - J Endourol. 2022 Nov;36(11):1444-1451. doi: 10.1089/end.2022.0262. Epub 2022 Aug 
      9.