Glienke Maximilian, Özkan Arif, Sigle August, Schoeb Dominik Stefan, Wilhelm Konrad, Schoenthaler Martin, von Bargen Maximilian Ferry, Gratzke Christian, Miernik Arkadiusz
Department of Urology, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany.
J Endourol. 2025 Aug;39(8):849-855. doi: 10.1177/08927790251360022. Epub 2025 Jul 14.
Holmium laser enucleation of the prostate (HoLEP) is an established surgical technique for treating benign prostatic enlargement with bladder outlet obstruction. Although HoLEP offers advantages such as reduced hospital stays and lower complication rates compared with traditional transurethral resection of the prostate, it presents a steep learning curve for surgeons. The number of procedures required to achieve proficiency remains debated, with estimates differing widely. This study aims to analyze the HoLEP learning curve beyond 200 cases, evaluating perioperative efficiency and complication rates in high-volume surgeons. A retrospective analysis was conducted on 1724 HoLEP procedures performed between 2015 and 2022 by six surgeons, three of whom had performed over 200 cases each. Key parameters assessed included operative time, enucleation efficiency, energy use, and complication rates. Statistical analyses included univariate and multivariate regression models to identify predictors of postoperative complications and efficiency improvements. The mean patient age was 70.48 years, with an average prostate volume of 93.43 g. The mean operative time was 80.68 minutes, with significant efficiency improvements correlating with increased surgeon experience ( < 0.001). Complication rates, including bleeding necessitating coagulation (4.7%) and urinary retention (9.3%), decreased significantly beyond 350 cases. Learning curves demonstrated a nonlinear reduction in complications and a continuous increase in surgical efficiency, with operative proficiency plateauing after approximately 350 procedures. Contrary to previous studies suggesting HoLEP proficiency after 50 to 60 cases, our findings indicate ongoing improvements beyond 200 cases, with stable complication rates achieved after 350 procedures. Structured mentorship programs and simulation-based training could facilitate faster learning and enhance patient outcomes.
钬激光前列腺剜除术（HoLEP）是一种治疗伴有膀胱出口梗阻的良性前列腺增生的成熟外科技术。尽管与传统经尿道前列腺切除术相比，HoLEP具有住院时间缩短和并发症发生率较低等优势，但它对外科医生来说学习曲线较陡。达到熟练水平所需的手术例数仍存在争议，估计差异很大。本研究旨在分析超过200例手术的HoLEP学习曲线，评估大量开展该手术的外科医生的围手术期效率和并发症发生率。对2015年至2022年间六位外科医生进行的1724例HoLEP手术进行了回顾性分析，其中三位医生每人完成了超过200例手术。评估的关键参数包括手术时间、剜除效率、能量使用和并发症发生率。统计分析包括单变量和多变量回归模型，以确定术后并发症和效率提高的预测因素。患者平均年龄为70.48岁，前列腺平均体积为93.43克。平均手术时间为80.68分钟，手术效率的显著提高与外科医生经验的增加相关（<0.001）。并发症发生率，包括需要凝血的出血（4.7%）和尿潴留（9.3%），在超过350例手术后显著降低。学习曲线显示并发症呈非线性减少，手术效率持续提高，在大约350例手术后手术熟练程度趋于平稳。与之前认为50至60例手术后达到HoLEP熟练水平的研究相反，我们的研究结果表明，超过200例手术后仍有持续改善，350例手术后并发症发生率稳定。结构化的导师指导计划和基于模拟的培训可以促进更快的学习并改善患者预后。
