Analysis of the top-down HoLEP learning curve: A single-center experience of two clinical fellows

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Daher K.; Fathy M.; Hodhod A.; Nikoufar P.; Alkandari A.; Abbas L.; Hadi R.A.; Elmansy H.

Journal: Archivio Italiano di Urologia e Andrologia

Publisher: Page Press Publications

Publication Date: 18 December 2024

Volume / Issue: Volume 96 / Issue 4

Article No.: 12997

ISSN: 11243562

DOI: 10.4081/aiua.2024.12862

Scopus: View on Scopus

PubMed: 39692424

Document Type: Article

Access: All Open Access; Gold Open Access

Authors and Affiliations

Daher K., Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Fathy M., Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada, Urology Department, Menoufia University, Menoufia, Egypt; Hodhod A., Urology Department, King Abdulaziz Medical City, National Guard Hospitals Affairs, Riyadh, Saudi Arabia; Nikoufar P., Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Alkandari A., Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Abbas L., Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada, Urology Department, Theodor Bilharz Research Institute, Giza, Egypt; Hadi R.A., Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Elmansy H., Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada

Abstract

Introduction: Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve. The top-down technique was introduced to lessen the number of procedures required to master HoLEP. We aimed to present the experiences of two successive clinical fellows with the top-down HoLEP learning curve and compare their performance with the supervisor. Methods: We conducted a prospective study of 40 patients who underwent top-down HoLEP performed by two successive fellows at our institution from September 2020 to November 2022. Before data collection, each learner observed three top-down HoLEP procedures and assisted with seven additional cases before independently performing top-down HoLEP under supervision. We collected data from each fellow's first 20 consecutive top-down HoLEP procedures. The learners' cases were grouped according to chronological order (Cases 1-10 and 11-20). The primary outcome was defined as the number of cases before the fellow could independently complete all steps of top-down HoLEP without any major intraoperative complications. The secondary outcomes included the intraoperative and postoperative outcomes of both groups. The fellows' 40 cumulative cases were then compared against retrospective data from 148 procedures conducted by their supervisor. Results: There were no significant differences in patient demographics for both clinical fellows. Each learner performed the first 20 cases independently without needing the supervisor to intervene. No major intraoperative complications were recorded, and there were no statistically significant differences in intraoperative and postoperative outcomes between fellows' cases. There was a statistically significant difference between the fellows and their supervisor in terms of operative efficiency and enucleation efficiency (p < 0.001). We did not find a significant difference between the fellows and the supervisor regarding intraoperative complications, major postoperative complications, or postoperative subjective and objective parameters. Conclusions: Top-down HoLEP shows promising and reproducible results in shortening HoLEP's learning curve. Larger comparative and multi-institutional studies are warranted. © 2024 Page Press Publications. All rights reserved.

Keywords

Benign prostatic hyperplasia; Minimal invasive; Prostate; Aged; Clinical Competence; Fellowships and Scholarships; Humans; Laser Therapy; Lasers, Solid-State; Learning Curve; Male; Middle Aged; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Retrospective Studies; adult; Article; clinical article; clinical practice; cohort analysis; comparative study; controlled study; demographics; follow up; holmium laser enucleation of the prostate; human; information processing; medical personnel; peroperative care; peroperative complication; personal experience; population research; postoperative care; prospective study; retrospective study; treatment outcome; very elderly; drug therapy; education; medical education; procedures; prostate hypertrophy; solid state laser; surgery

Citation Information

Scopus Citations: 1

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