[HoLEP learning curve: Toward a standardised formation and a team strategy].
OBJECTIVE
Holmium laser enucleation of prostate (HoLEP) is renowned for the difficulty of its learning curve. Our aim was to evaluate the interest of a three-step tutorial in the HoLEP learning curve, in a university center.


METHODS
It is a retrospective, monocentric study of the 82 first procedures done consecutively by the same operator with a proctoring in early experience and after 40 procedures. For all patients were noted: enucleation efficiency (g/min), morcellation efficiency (g/min), percentage of enucleated tissue (enucleated tissue/adenome weigth evaluated by ultrasonography. g/g), perioperative morbidity (Clavien), length of hospital stay, length of urinary drainage, functional outcomes at short and middle term (Qmax, post-void residual volume [PVR], QOL scores and IPSS at 3 and 6months).


RESULTS
Enucleation and morcellation efficiency were significantly higher after the second proctoring (0.87 vs 0.44g/min; P<0.0001 and 4.2 vs 3.37g/min, P=0.038, respectively) so as the prostatic volume (43.5 vs 68.1mL, P=0.0001). Percentage of enucleated tissue was higher in the second group, however, the difference was not significant (69.5% vs 80.4%, P=0.03). Per- and postoperative complications, hospital length of stay, urinary drainage length and functional results at 3 and 6months were not significantly different.


CONCLUSIONS
The learning curve did not interfere with functional results. The second proctoring was essential to us in order to grasp the technique. These data underlined the necessity of a pedagogic reflexion in order to built a standardized formation technique to the HoLEP.


METHODS
4.
Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France.
M
M
Baron
Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France.
F-X
FX
Nouhaud
Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France.
C
C
Delcourt
Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France.
P
P
Grise
Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France.
C
C
Pfister
Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France. Electronic address: jean-nicolas.cornu@chu-rouen.fr.
J-N
JN
Cornu
Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France.
L
L
Sibert
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000193:education* / Q000379:methods; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies
Courbe d’apprentissage; Enucleation; Formation; Laser; Learning curve; Proctoring; Prostate; Énucléation