Daher Karim, Fathy Moustafa, Hodhod Amr, Nikoufar Parsa, Alkandari Abdulrahman, Abbas Loay, Abdul Hadi Ruba, Elmansy Hazem
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario.
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Urology Department, Menoufia University, Menoufia.
Arch Ital Urol Androl. 2024 Dec 18;96(4):12862. doi: 10.4081/aiua.2024.12862.
Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve. The top-down technique was introduced to lessen the number of procedures required to master HoLEP. We aimed to present the experiences of two successive clinical fellows with the top-down HoLEP learning curve and compare their performance with the supervisor.
We conducted a prospective study of 40 patients who underwent top-down HoLEP performed by two successive fellows at our institution from September 2020 to November 2022. Before data collection, each learner observed three top-down HoLEP procedures and assisted with seven additional cases before independently performing top-down HoLEP under supervision. We collected data from each fellow's first 20 consecutive top-down HoLEP procedures. The learners' cases were grouped according to chronological order (Cases 1-10 and 11-20). The primary outcome was defined as the number of cases before the fellow could independently complete all steps of top-down HoLEP without any major intraoperative complications. The secondary outcomes included the intraoperative and postoperative outcomes of both groups. The fellows' 40 cumulative cases were then compared against retrospective data from 148 procedures conducted by their supervisor.
There were no significant differences in patient demographics for both clinical fellows. Each learner performed the first 20 cases independently without needing the supervisor to intervene. No major intraoperative complications were recorded, and there were no statistically significant differences in intraoperative and postoperative outcomes between fellows' cases. There was a statistically significant difference between the fellows and their supervisor in terms of operative efficiency and enucleation efficiency (p < 0.001). We did not find a significant difference between the fellows and the supervisor regarding intraoperative complications, major postoperative complications, or postoperative subjective and objective parameters.
Top-down HoLEP shows promising and reproducible results in shortening HoLEP's learning curve. Larger comparative and multi-institutional studies are warranted.
钬激光前列腺剜除术（HoLEP）的学习曲线较陡。自上而下技术的引入是为了减少掌握HoLEP所需的手术次数。我们旨在介绍两位连续临床学员在自上而下HoLEP学习曲线方面的经验，并将他们的表现与带教老师进行比较。
我们对2020年9月至2022年11月在我院由两位连续学员进行的40例自上而下HoLEP手术患者进行了前瞻性研究。在收集数据之前，每位学员观察了3例自上而下HoLEP手术，并在监督下协助完成另外7例手术，之后独立进行自上而下HoLEP手术。我们收集了每位学员连续进行的前20例自上而下HoLEP手术的数据。学员的病例按时间顺序分组（病例1 - 10和11 - 20）。主要结局定义为学员能够独立完成自上而下HoLEP的所有步骤且无任何重大术中并发症之前的病例数。次要结局包括两组的术中及术后结局。然后将学员的40例累积病例与他们的带教老师进行的148例手术的回顾性数据进行比较。
两位临床学员的患者人口统计学特征无显著差异。每位学员独立完成了前20例病例，无需带教老师干预。未记录到重大术中并发症，学员病例的术中及术后结局无统计学显著差异。在手术效率和剜除效率方面，学员与带教老师之间存在统计学显著差异（p < 0.001）。在术中并发症（主要术后并发症或术后主观和客观参数）方面，我们未发现学员与带教老师之间存在显著差异。
自上而下HoLEP在缩短HoLEP学习曲线方面显示出有前景且可重复的结果。有必要进行更大规模的比较性和多机构研究。
