The effect of past experience of TUR-P on overcoming learning curve of HOLEP
Dr. R Bae (1), Professo Ki Soo Lee (2), Professor Tae Wook Kang (3), Professor Yong Seok Lee (1), Professor Bong Hee Park (1), Professor Wong Yeol Cho (2), Professor Sung Hak Kang (1), Professor Chang Hee Han (1)
(1) The Catholic University Of Korea, Uijeongbu St.mary's Hospital, Gyeonggi-do, South Korea, (2) Dong A University Hospital, College of medicine, Dong A University , , South Korea, (3) Wonju Severance Hospital, College of medicine, The Yonsei University, Wonju, South Korea
The purpose of this study was to evaluate the effect of the amount of experience and the experience of the conventional TUR-P on overcoming the learning curve of HoLEP.
From 2012 to 2017, HoLEP was performed in patients with prostate hyperplasia in a single institution. Three surgeons who performed TUR-P in more than 300 cases(highly experienced, HE), 100-200 cases(moderate experienced, ME), and less than 10 TUR-P cases(beginner) were analyzed electronical medical records. All of the surgeons experienced HoLEP for the first time and confirmed the timing of overcoming the learning curve. They also evaluated the operation time, enucleation time, morcellation time, transfusion status, objective indicators such as uroflowmetry and residual urine scan, the preoperative and postoperative results were compared through subjective indices.
Total 302 patients were included in this analysis. 117 patients were underwent HoLEP by HE, 107 patients by ME, 78 patients by beginner. All 3 surgeons was winning learning curve after 30 cases. Compared to HE surgeon, beginner had more frequent transfusion rate(0.22 PRC pack vs. 0.43 PRC Pack), more large volume of pre- and postoperative residual urine(98.89 vs. 159.60cc, 46.54 vs. 58.83cc), Preoperative voiding symptoms and storage symptom scores were high (IPSS voiding 2.25 vs. 7.02, storage 1.75 vs. 5.14) There was no significant difference after the operation(voiding 2.72 vs. 3.41, storage 3.35 vs. 4.63) The efficacy of energy, enucleation, and morcellation were higher than ME.(0.41vs.1.26, 0.50 vs.1.23, 3.29 vs. 4.35) Compared with HE, the morcellation time was relatively long(12.01 vs. 17.57min), Energy efficacy and enucleation were also higher than ME, but the difference was not more severe than HE. (0.82 vs 1.26 vs. 0.80 vs 1.23)
The experience of TUR-P did not have a great effect on learning HoLEP. The less knowledge about the existing prostate surgery was rather more cautious, and sometimes it helped the operation to proceed efficiently.