The Learning Curve for Holmium Laser Enucleation of the Prostate: A Single-Center Experience
배정범, 오승준, 백재승,
소속 상세정보
배정범 ( Bae Jung-Bum )
서울대학교 의과대학 비뇨기과학교실
오승준 ( Oh Seung-June )
서울대학교 의과대학 비뇨기과학교실
백재승 ( Paick Jae-Seung )
서울대학교 의과대학 비뇨기과학교실
KMID : 0358320100510100688
Abstract
PurposeHolmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve and, as a result, its clinical usage has limitations. The purpose of this study was to analyze the learning curve and early complications following the HoLEP procedure.
Materials and MethodsA retrospective analysis was performed on 161 patients who had undergone the HoLEP procedure for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) from July 2008 to September 2009. The procedure was done by two surgeons. Perioperatively, enucleated tissue weight, enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), and enucleation efficiency (enucleated weight/enucleation time) were analyzed, and early complications were assessed.
ResultsMean enucleation time, morcellation time, and enucleation ratio were 61.3 min (range, 10-180 min), 12.3 min (range, 2-60 min), and 0.66 (range, 0.07-2.51), respectively. In terms of efficiency, enucleation efficiency was 0.32 g/min (range, 0.02-1.25 g/min) and morcellation efficiency was 1.73 g/min (range, 0.1-7.7 g/min). Concerning the learning curve, enucleation efficiency was stationary after 30 cases (p<0.001), morcellation efficiency reached a learning curve at 20 cases (p=0.032), and enucleation ratio had no learning curve in this study. There were several cases of surgery-related complications, including bladder mucosal injury by the morcellator (13%), capsular injury during enucleation (7%), and conversion to a conventional resectoscopy procedure (15%), which showed a reduction in incidence with time.
ConclusionsThe learning curve of HoLEP is steep; however, it can be overcome gradually. Further study is necessary with respect to long-term postoperative follow-up.
키워드
Holmium;Lasers;Learning;Prostate;Prostatic hyperplasia
원문 및 링크아웃 정보
등재저널 정보