Presented by: Rajat Jain MD
University of Rochester Medical Center, Department of Urology

Introduction

Holmium laser enucleation of the prostate (HoLEP) has been proposed as the “Platinum Standard” for BPH therapy. The steep learning curve of HoLEP compared to other modalities has led to its lack of utilization. The objective of this study is to determine the best metrics for assessing the early learning curve progression of HoLEP.

Materials

The first 40 HoLEP cases of two surgeons were evaluated using the following metrics: total OR time, enucleation time, total OR time/prostate volume preop, total OR time/prostate weight resected, enucleation time/prostate volume preop, enucleation time/prostate volume weight resected, enucleation time/laser time, and prostate volume preop/prostate weight resected. Scatter plots for both surgeons were created of the number of cases vs the metric of the HoLEP learning curve being evaluated. A best-fit line was calculated using least squares regression and the goodness-of-fit was compared using R² (Table 1).

Results

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Enucleation time/laser time was the most strongly correlated measure of the learning curve for both surgeons: Surgeon A (R² = 0.26) and Surgeon B (R² = 0.5) (Figure 1). There was no or very weak correlation with other learning curve metrics.

Conclusion

Studies estimate it takes 25-50 cases to become acquainted with the steep learning curve associated with HoLEP. Different aspects of the procedure have variable learning curves. Identifying early metrics associated with the learning curve may aid in tracking a surgeon’s competency. Our study demonstrates enucleation time/laser time, a measure of the efficiency of active laser use compared to total enucleation time, as a metric to track proficiency and identify surgeons who need additional attention in enucleation efficiency. Metrics related to volume or specimen weight are thought to add difficulty to the procedure but are not correlated in this early learning phase.

Funding

None

Lead Authors

Alexander Chait,
University of Rochester Medical Center, Department of Urology

Co-Authors

David Song,
University of Rochester Medical Center, Department of Urology

Karen Doersch, MD, PhD
University of Rochester Medical Center, Department of Urology

Scott Quarrier, MD, MPH
University of Rochester Medical Center, Department of Urology