title: Holmium laser enucleation of the prostate: efficiency gained by experience and operative technique.
abstract: OBJECTIVE
  Holmium laser enucleation of the prostate is highly effective for symptomatic benign prostatic hyperplasia. Despite its steep learning curve the procedure is an efficient treatment, especially for large prostate glands. We determined the change in enucleation efficiency with time with increased operative experience and improved technique.
  
  
  METHODS
  We reviewed the records of all 949 consecutive men who underwent holmium laser enucleation of the prostate between 1999 and 2007. Patients were excluded from analysis when enucleated gm or time was not recorded and enucleated tissue was less than 5 gm. Efficiency was measured in gm enucleated prostate tissue per minute. Descriptive statistics on laser time, gland weight and efficiency were evaluated in an 8-year period.
  
  
  RESULTS
  A total of 91 patients met study exclusion criteria, leaving 858 available for evaluation. Mean enucleation time was 94 minutes (range 12 to 485). Mean prostate specimen weight was 77 gm (range 5 to 376). Mean efficiency or enucleation rate was 0.55 vs 1.32 gm per minute in the first 4 vs the last 5 years. Further efficiency improvements were noted in the last 5 years with a mean of 1.57 gm per minute enucleated in the last 2 years.
  
  
  CONCLUSIONS
  As experience with holmium laser enucleation of the prostate grows, advances in operative technique have been made. Prostatic enucleation efficiency continues to improve, further strengthening the role of holmium laser enucleation of the prostate for benign prostatic hyperplasia of small and large prostate glands.
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Dusing
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
authors.forename: Colin
authors.initials: C
authors.lastname: Terry
authors.forename: Brian R
authors.initials: BR
authors.lastname: Matlaga
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Humphreys
authors.forename: Ehud
authors.initials: E
authors.lastname: Gnessin
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000379:methods / Q000592:standards*