Evaluation of the learning curve for Thulium VapoEnucleation of the prostate (ThuVEP) using a mentor-based approach.
BACKGROUND
To evaluate the learning curve of Thulium:YAG VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) prospectively.


METHODS
ThuVEP was performed using the 120 Watt 2 μm continuous wave Thulium:YAG laser. ThuVEP was done by a resident without experience in transurethral prostate surgery (A, n = 32), an experienced endourologist (B, n = 32), and an experienced surgeon in ThuVEP (C, n = 32), who served as the mentor for A/B. Patients were divided into consecutive subgroups of 8 patients to assess the impact of the learning curve on procedure outcome. Patient demographic, perioperative, and 12-month follow-up data were analysed.


RESULTS
ThuVEP was successfully completed in all patients. Enucleation efficiency (g/min) differed significantly between surgeon A (0.48 ± 0.3), B (0.7 ± 0.36), and C (1.4 ± 0.67) (p ≤ 0.001). Enucleation efficiency correlated significantly with the weight of resected tissue in surgeon A (r = 0.88), B (r = 0.73), and C (r = 0.79) (p < 0.001). ThuVEP was performed by surgeon A and B with reasonable enucleation, morcellation, and overall operation efficiency after 8-16 procedures. At 12-month follow-up, 68 (71 %) patients were available for review. IPSS, QoL, Qmax, PVR, PSA, and prostate volume improved significantly at follow-up (p ≤ 0.023). Mean PSA/prostate volume reduction was 81.95/74.5, 80.7/79.4, and 87.6/75.9 % in surgeon A, B, and C, respectively. Urethral stricture and bladder neck contracture developed 2 (A = 1, B = 1; 2.1 %) patients and 1 (C, 1 %) patient each, respectively.


CONCLUSIONS
ThuVEP can be performed with reasonable efficiency even during the initial learning course of the surgeon when closely mentored. Previous experience in the field of endourology is beneficial.
Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany, c.netsch@asklepios.com.
C
C
Netsch
T
T
Bach
T R W
TR
Herrmann
O
O
Neubauer
A J
AJ
Gross
D000236:Adenoma / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D053844:Lasers, Solid-State; D059032:Learning Curve; D008297:Male; D008611:Mentors; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000601:surgery; D011471:Prostatic Neoplasms / Q000601:surgery; D013932:Thulium; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
D013932:Thulium