Abstract：
OBJECTIVE: To assess the learning curve of Thulium Fiber Laser Enucleation of prostate (ThuFLEP) of a single surgeon inexperienced in laser endoscopic enucleation of prostate (EEP).
METHODS: We retrospectively analyzed all patients with benign prostate hyperplasia undergoing ThuFLEP at our center between January 2022 and August 2023 by one surgeon. Inclusion criteria were International Prostate Symptom Score > 7, prostate volume < 200 g, and maximal urinary flow rate < 15 mL/s. The surgeon was inexperienced in laser EEP and trained by watching educational videos of ThuFLEP before starting to perform the procedure under mentoring during the first 4 cases. Procedural data (enucleation and morcellation efficiency, complications) and functional results up to 3 months were evaluated. Patients were divided into 4 cohorts of 20 consecutive cases to evaluate outcomes evolution throughout time.
RESULTS: The mean age of the patients was 69.9 years (SD 7.8) and mean prostate volume was 89.9 g (SD 25.8). Preoperative functional parameters were comparable between the groups. Mean enucleation efficiency (EE) ratio and morcellation efficiency (ME) ratio reached respectively 0.78 g/min (SD 0.55) and 2.49 g/min (SD 1.03) and both variables significantly increased from group 1 to group 3 (p < 0,001). Perioperative complications remained low throughout the caseload with similar significant 3-month functional improvements between all groups.
CONCLUSIONS: This is the first study to evaluate ThuFLEP learning curve for a single surgeon inexperienced in laser EEP with limited mentoring. Under these real-world conditions, nearly 60 cases were needed to complete the learning curve with a complications rate remaining low throughout the training process.
METHODS: We retrospectively analyzed all patients with benign prostate hyperplasia undergoing ThuFLEP at our center between January 2022 and August 2023 by one surgeon. Inclusion criteria were International Prostate Symptom Score > 7, prostate volume < 200 g, and maximal urinary flow rate < 15 mL/s. The surgeon was inexperienced in laser EEP and trained by watching educational videos of ThuFLEP before starting to perform the procedure under mentoring during the first 4 cases. Procedural data (enucleation and morcellation efficiency, complications) and functional results up to 3 months were evaluated. Patients were divided into 4 cohorts of 20 consecutive cases to evaluate outcomes evolution throughout time.
RESULTS: The mean age of the patients was 69.9 years (SD 7.8) and mean prostate volume was 89.9 g (SD 25.8). Preoperative functional parameters were comparable between the groups. Mean enucleation efficiency (EE) ratio and morcellation efficiency (ME) ratio reached respectively 0.78 g/min (SD 0.55) and 2.49 g/min (SD 1.03) and both variables significantly increased from group 1 to group 3 (p < 0,001). Perioperative complications remained low throughout the caseload with similar significant 3-month functional improvements between all groups.
CONCLUSIONS: This is the first study to evaluate ThuFLEP learning curve for a single surgeon inexperienced in laser EEP with limited mentoring. Under these real-world conditions, nearly 60 cases were needed to complete the learning curve with a complications rate remaining low throughout the training process.
摘要：
目的：评估一位在激光内镜下前列腺摘除术（EEP）中没有经验的外科医师的thulium光纤前列腺摘除术（ThuFLEP）学习曲线。
方法：我们回顾性分析了2022年1月至2023年8月在我们中心由一名外科医生进行ThuFLEP的所有良性前列腺增生患者。纳入标准为国际前列腺症状评分>7，前列腺体积<200g，最大尿流率<15mL/s。外科医生对激光EEP缺乏经验，并在前4例病例中开始在指导下进行手术之前，通过观看ThuFLEP的教育视频进行了培训。程序数据(摘除和粉碎效率，并发症）和长达3个月的功能结果进行评估。将患者分为4组，每组20例，以评估整个时间的结果演变。
结果：患者的平均年龄为69.9岁（SD7.8），平均前列腺体积为89.9g（SD25.8）。两组之间的术前功能参数具有可比性。平均摘除效率（EE）比率和碎裂效率（ME）比率分别达到0.78g/min（SD0.55）和2.49g/min（SD1.03），并且两个变量从组1到组3显着增加（p<0.001）。在整个病例中，围手术期并发症仍然很低，所有组之间3个月的功能改善相似。
结论：这是第一项评估ThuFLEP学习曲线的研究，该研究是针对没有激光EEP经验且指导有限的单一外科医生。在这些现实世界的条件下，完成学习曲线需要近60例病例,在整个训练过程中并发症发生率保持较低.
方法：我们回顾性分析了2022年1月至2023年8月在我们中心由一名外科医生进行ThuFLEP的所有良性前列腺增生患者。纳入标准为国际前列腺症状评分>7，前列腺体积<200g，最大尿流率<15mL/s。外科医生对激光EEP缺乏经验，并在前4例病例中开始在指导下进行手术之前，通过观看ThuFLEP的教育视频进行了培训。程序数据(摘除和粉碎效率，并发症）和长达3个月的功能结果进行评估。将患者分为4组，每组20例，以评估整个时间的结果演变。
结果：患者的平均年龄为69.9岁（SD7.8），平均前列腺体积为89.9g（SD25.8）。两组之间的术前功能参数具有可比性。平均摘除效率（EE）比率和碎裂效率（ME）比率分别达到0.78g/min（SD0.55）和2.49g/min（SD1.03），并且两个变量从组1到组3显着增加（p<0.001）。在整个病例中，围手术期并发症仍然很低，所有组之间3个月的功能改善相似。
结论：这是第一项评估ThuFLEP学习曲线的研究，该研究是针对没有激光EEP经验且指导有限的单一外科医生。在这些现实世界的条件下，完成学习曲线需要近60例病例,在整个训练过程中并发症发生率保持较低.
