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Abstract：
OBJECTIVE: To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases.
METHODS: Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1-5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test.
RESULTS: Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1).
CONCLUSIONS: HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time.
METHODS: Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1-5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test.
RESULTS: Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1).
CONCLUSIONS: HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time.
摘要：
目的：评估围手术期参数，临床结果，以及500例连续手术中单个外科医生的前列腺钬激光摘除术（HoLEP）的学习曲线。
方法：人口统计学参数，结果，并对不良事件进行了评估。使用Wilcoxen秩检验分析了前500名连续患者的整体技术中HoLEP的学习曲线，分为100个簇（簇1-5），Chi²testandKruskalWallistest.
结果：在簇1、2、3和5中，去核重量相似（62g，63g,61g,61g)，在第4组中，它略高于73g。操作时间从67分钟（第1组）显着减少到57分钟（第2组），46分钟(集群3)，53分钟(集群4)，43分钟(第5组)，p<0.001。眼球摘除效率（g/min）显示稳定增加（1.72、2.24、2.79、2.92vs.2.99，p<0.001)。激光能量效率也有所提高（2.17vs.2.12vs.1.71vs.1.65vs.1.55；p<0.001）。关于住院时间（平均2.5天），没有可衡量的学习曲线，导管插入时间（1.9天），血红蛋白下降（约。1g/dl）或并发症（p>0.1）。
结论：使用整体技术的HoLEP是一种安全且高效的方法。随着时间的推移,轻微但稳定的学习曲线和运行时间的改善，即使对于有经验的外科医生，在500例病例之后，也显示了眼球摘除效率和激光能量效率。仍然没有达到高原。关于失血没有可测量的学习曲线，并发症,住院时间,和导管插入时间。
方法：人口统计学参数，结果，并对不良事件进行了评估。使用Wilcoxen秩检验分析了前500名连续患者的整体技术中HoLEP的学习曲线，分为100个簇（簇1-5），Chi²testandKruskalWallistest.
结果：在簇1、2、3和5中，去核重量相似（62g，63g,61g,61g)，在第4组中，它略高于73g。操作时间从67分钟（第1组）显着减少到57分钟（第2组），46分钟(集群3)，53分钟(集群4)，43分钟(第5组)，p<0.001。眼球摘除效率（g/min）显示稳定增加（1.72、2.24、2.79、2.92vs.2.99，p<0.001)。激光能量效率也有所提高（2.17vs.2.12vs.1.71vs.1.65vs.1.55；p<0.001）。关于住院时间（平均2.5天），没有可衡量的学习曲线，导管插入时间（1.9天），血红蛋白下降（约。1g/dl）或并发症（p>0.1）。
结论：使用整体技术的HoLEP是一种安全且高效的方法。随着时间的推移,轻微但稳定的学习曲线和运行时间的改善，即使对于有经验的外科医生，在500例病例之后，也显示了眼球摘除效率和激光能量效率。仍然没有达到高原。关于失血没有可测量的学习曲线，并发症,住院时间,和导管插入时间。
