Presented by: ARCHANA RAYSEE Ms/ MBBS, MRCS
Maidstone and Tunbridgewells foundation trust

Introduction

HoLEP is considered as a popular procedure for treatment of bladder outlet obstruction secondary to prostatic enlargement. Various techniques have been introduced to perform the procedure, sometime depending on surgeon’s experience and choice. We have studied the data in our hospital to assess the efficiency of the procedure by different surgeons.

Materials

Data was collected prospectively for 305 consecutive patients who underwent HoLEP from 1/12/2020 to 1/12/2022 Efficiency was calculated by assessing the weight of tissue removed over the total operative time (gm/min). Data was referenced for 5 surgeons at the site . Comparison of the impact of surgeon experience and technique on HoLEP efficiency. Parameters included: - estimated prostate size (cc) on either DRE, USS, CT, or MRI; - surgical technique (en-bloc, 2-lobe, or 3 lobe) - specimen weight (gm); - operating surgeon and - duration of operation

Results

,

Across all cases, the mean prostate size was 105cc with mean operative time of 90 minutes, thus giving the departmental average efficiency of 0.66gm/min. Surgeon MSC utilised an en-bloc technique with an average efficiency of 0.77gm/min (for mean prostates size 133cc and mean enucleated weight 68.4gm, n=68) .

Surgeon BP performed en-bloc and 2 lobe enucleation in 70:90 of cases (n=160) with an efficiency of 0.69gm/min

The remainder of surgeons performed 2 or 3 lobe techniques, resulting in average efficiency of 0.54gm/min (n=38), 0.5gm/min (n=25) and 0.43gm/min (n=14) for surgeons AH, TS and HY, respectively

Conclusion

The data demonstrates positive correlation between surgeon experience/case load and efficiency of the operation. • En-bloc surgical technique and larger prostate size are also associated with increased efficiency. • These findings could have implications for theatre planning, optimising surgical technique and approaches to training future HoLEP fellows

Funding

Nothing to declare

Lead Authors

Phillip McCarthy, MBBS, BSC
Maidstone and Tunbridge Wells NHS Trust

Branimir Penev, Mr / MBBS, DNB (Urol), FEBU, FRCS (Urol)
Maidstone and Tunbridge Wells Hospital

Mark Cynk, Mr / MBBS, MSc, FRCS(Urol)
Maidstone and Tunbridge Wells NHS Trust