title: Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate.
abstract: OBJECTIVE
  To appraise the evaluation methods for learning curve and to analyze the non-mentor-aided learning curve and early complications following the holmium laser enucleation of the prostate.
  
  
  METHODS
  One-hundred and forty (n=140) consecutive patients who underwent HoLEP from July 2008 to July 2010 by a single surgeon (SJO) were enrolled. Perioperative clinical variables, including enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), enucleation efficacy (enucleated weight/enucleation time), enucleation ratio efficacy (enucleation ratio/enucleation time), and early complication rate were analyzed.
  
  
  RESULTS
  Mean prostate volume was 62.7 mL (range 21-162) and preoperative International Prostate Symptom Score (IPSS) was 19.0 (4-35). Mean enucleation time and morcellation time were 49.9 ± 23.8 (S.D.) min and 11.0 ± 9.7 min, respectively. Median duration of postoperative indwelling catheter was 1 (1-7) day and median hospital stay was 1 (1-6) day. There were a total of 31 surgery-related complications in 27 patients (19.3%), and all were manageable. There was an increasing trend of enucleation efficacy in the first 50 cases. However, enucleation efficacy was linearly correlated with the prostate size (correlation coefficients, R=0.701, p<0.001). But, enucleation ratio efficacy could eliminate the confounding effect of the prostate size (R=-0.101, p=0.233). The plateau of enucleation ratio efficacy was reached around the twenty-fifth case.
  
  
  CONCLUSIONS
  Our results demonstrated that the operative learning curve plateau is reached after about 25 cases. We propose that a more appropriate parameter for estimating the operative learning curve is enucleation ratio efficacy, rather than enucleation efficacy.
authors: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors: Chang Wook
authors: CW
authors: Jeong
authors: Jin Kyu
authors: JK
authors: Oh
authors: Min Cchul
authors: MC
authors: Cho
authors: Jung-Bum
authors: JB
authors: Bae
authors: Seung-June
authors: SJ
authors: Oh
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome