Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany,
World J Urol. 2013 Oct;31(5):1231-8. doi: 10.1007/s00345-012-0894-1. Epub 2012 Jun 24.
To evaluate the learning curve of Thulium:YAG VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) prospectively.
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.
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.
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.
前瞻性评估有症状良性前列腺梗阻（BPO）患者行钬激光前列腺剜除术（ThuVEP）的学习曲线。
使用 120 瓦 2μm 连续波钬激光行 ThuVEP。由一位没有经尿道前列腺切除术经验的住院医师（A 组，n=32）、一位经验丰富的腔内泌尿外科医师（B 组，n=32）和一位 ThuVEP 经验丰富的外科医生（C 组，n=32）进行操作，A/B 由 C 作为导师指导。将患者分为 8 例连续亚组，以评估学习曲线对手术结果的影响。分析患者的人口统计学、围手术期和 12 个月随访数据。
所有患者均成功完成 ThuVEP。外科医生 A（0.48±0.3）、B（0.7±0.36）和 C（1.4±0.67）之间的前列腺剜除效率（g/min）差异有统计学意义（p≤0.001）。外科医生 A（r=0.88）、B（r=0.73）和 C（r=0.79）的前列腺剜除效率与切除组织的重量显著相关（p<0.001）。在 8-16 次手术后，A 组和 B 组可以合理地进行剜除、切碎和整体手术效率。在 12 个月的随访中，68（71%）例患者可供复查。国际前列腺症状评分（IPSS）、生活质量评分（QoL）、最大尿流率（Qmax）、前列腺体积（PVR）、前列腺特异性抗原（PSA）和前列腺体积均有显著改善（p≤0.023）。外科医生 A、B 和 C 的 PSA/前列腺体积的平均减少率分别为 81.95%/74.5%、80.7%/79.4%和 87.6%/75.9%。尿道狭窄和膀胱颈挛缩分别发生于 2 例（A=1 例，B=1 例；2.1%）和 1 例（C，1%）患者。
在密切指导下，即使是在外科医生最初的学习阶段，也可以以合理的效率进行 ThuVEP。之前在腔内泌尿外科领域的经验是有益的。
