Impact of mentoring in the perioperative safety of ThuFLEP technique. A two-center retrospective comparative study.

BACKGROUND

Endoscopic enucleation of the prostate (EEP) has become a gold standard for the surgical treatment of symptomatic benign prostatic hyperplasia (BPH). Thulium fiber laser enucleation (ThuFLEP), due to its characteristics, may facilitate quicker and easier adoption for novice surgeons. This study compares the feasibility and the safety of ThuFLEP technique between two novice EEP teams, one with an on-site mentor and one without.

MATERIALS AND METHODS

The study involved 110 patients across two centers. The first, with a mentor (Center M), performed 50 procedures, while the second, without a mentor (Center W), performed 60. The primary endpoint focused on feasibility and perioperative complications. Secondary endpoints included operative efficiency and functional outcomes at three months.

RESULTS

Among post-operative complications, only the transfusion rate differed between the centers (Center M: 4 vs. Center W: 0; P=0.03). Median duration of enucleation and morcellation were respectively 89% longer (P=0.00001) and 75% longer (P=0.00037) in Center W. Enucleation and morcellation efficiencies were respectively 74% (0.87g/min vs. 0.50g/min; P=0.0013) and 42% (3.75g/min vs. 2.62g/min; P=0.0046) lower without a mentor. Three-month functional outcomes were comparable, except for maximum urinary flow, which was higher in the group without a mentor (24.5mL/s vs. 15.5mL/s; P<0.01).

CONCLUSIONS

The acquisition of the ThuFLEP technique by novice surgeons is feasible and safe without a mentor, although having one improves operative time and efficiency.