title: [Assessment of the learning curves for intravesical adenoma morcellation using Piranha©device during endoscopic enucleation].
abstract: BACKGROUND
  Morcellation of intravesical adenoma (MIA) is an important part of the endoscopic enucleation procedure. The aim of this study was to analyse the learning curve of the MIA during endoscopic enucleation of the prostate.
  
  
  METHODS
  We conducted a prospective study of the first 90 patients treated by endoscopic enucleation of the prostate by a single surgeon without previous experience of MIA. The population was divided into 3 consecutive groups of 30 patients. MIA was performed with the morcellator Pinranha (Wolf) and disposable blades (Vmax©). The criteria selected to assess the progress of MIA over time were: duration of MIA (min), the intraoperative complications encountered during MIA and weight morcelleted tissue. The efficacy of MIA was assessed with the ratio weight specimen/MIA duration (min/g) over time.
  
  
  RESULTS
  The three groups were comparable in terms of age, ASA score of prostate volume. A significant decrease in the duration of MIA was found between groups 1 and 2 (12 versus 5.5min, P<0.0001), to reach a plateau in the group 3 (3min). A significant increase in the efficiency of MIA was found between group 1 and 2 (5.5 versus 11g/min, P<0.0001), to reach a plateau in the group 3 (20g/min). Bladder injuries were limited (7.7%), superficial and encountered in the early learning phase.
  
  
  CONCLUSIONS
  In our experience, the MIA required a learning curve estimated between 30 and 60 procedures.
  
  
  METHODS
  IV.
authors.affiliation: Service d'urologie, clinique Pasteur, 45, avenue de Lombez, 31300 Toulouse, France. Electronic address: v.misrai@clinique-pasteur.com.
authors.forename: V
authors.initials: V
authors.lastname: Misrai
authors.affiliation: Service d'urologie, clinique Pasteur, 45, avenue de Lombez, 31300 Toulouse, France.
authors.forename: B
authors.initials: B
authors.lastname: Bordier
authors.affiliation: Service d'urologie, clinique Pasteur, 45, avenue de Lombez, 31300 Toulouse, France.
authors.forename: J
authors.initials: J
authors.lastname: Guillotreau
mesh_terms: D000368:Aged; D003558:Cystoscopy; D004867:Equipment Design; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D000069577:Morcellation / Q000193:education* / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000601:surgery*; D001743:Urinary Bladder; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods
keywords: Adenoma; Adénome; Courbe d’apprentissage; Enucleation; Learning curves; Morcellation; Prostate; Énucléation