Evaluation of the learning curve for thulium laser enucleation of the prostate with the aid of a simulator tool but without tutoring: comparison of two surgeons with different levels of endoscopic experience

BMC Urology

Research Article

Federico Sembenini¹  Giacomo Borroni²  Jon Alexander Lovisolo³  Giovanni Saredi⁴  Alberto Mario Marconi⁴  Andrea Pacchetti⁴  Giacomo Maria Pirola⁵ 

[1] Department of Statistics, Bicocca University, Milan, Italy;Department of Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy;Department of Urology, Ospedale di Circolo di Busto Arsizio, Saronno, Italy;Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy;Department of Urology, University of Modena e Reggio Emilia, viale Borri, 57, 21100, Varese, Modena, Italy;

关键词: Benign prostatic hyperplasia;    Endourology;    Laser surgery;    Prostate disease;    Simulator;   

DOI  :  10.1186/s12894-015-0045-2

 received in 2014-11-09, accepted in 2015-06-02,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe aim of this study was to determine the learning curve for thulium laser enucleation of the prostate (ThuLEP) for two surgeons with different levels of urological endoscopic experience.MethodsFrom June 2012 to August 2013, ThuLEP was performed on 100 patients in our institution. We present the results of a prospective evaluation during which we analyzed data related to the learning curves for two surgeons of different levels of experience.ResultsThe prostatic adenoma volumes ranged from 30 to 130 mL (average 61.2 mL). Surgeons A and B performed 48 and 52 operations, respectively. Six months after surgery, all patients were evaluated with the International Prostate Symptom Score questionnaire, uroflowmetry, and prostate-specific antigen test. Introduced in 2010, ThuLEP consists of blunt enucleation of the prostatic apex and lobes using the sheath of the resectoscope. This maneuver allows clearer visualization of the enucleation plane and precise identification of the prostatic capsule. These conditions permit total resection of the prostatic adenoma and coagulation of small penetrating vessels, thereby reducing the laser emission time. Most of the complications in this series were encountered during morcellation, which in some cases was performed under poor vision because of venous bleeding due to surgical perforation of the capsule during enucleation.ConclusionsBased on this analysis, we concluded that it is feasible for laser-naive urologists with endoscopic experience to learn to perform ThuLEP without tutoring. Those statements still require further validation in larger multicentric study cohort by several surgeon. The main novelty during the learning process was the use of a simulator that faithfully reproduced all of the surgical steps in prostates of various shapes and volumes.

【 授权许可】

Unknown   
© Saredi et al. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.