Evaluation of the learning curve for Thulium VapoEnucleation of the prostate (ThuVEP) using a mentor-based approach
ABSTRACT INTRODUCTION: To evaluate the learning curve of Thulium:YAG VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) prospectively. METHODS: ThuVEP was performed using the 120 Watt 2 μm continuous wave Thulium:YAG laser. ThuVEP was done by a resident without experience in transurethral prostate surgery (A, n = 32), an experienced endourologist (B, n = 32), and an experienced surgeon in ThuVEP (C, n = 32), who served as the mentor for A/B. Patients were divided into consecutive subgroups of 8 patients to assess the impact of the learning curve on procedure outcome. Patient demographic, perioperative, and 12-month follow-up data were analysed. RESULTS: ThuVEP was successfully completed in all patients. Enucleation efficiency (g/min) differed significantly between surgeon A (0.48 ± 0.3), B (0.7 ± 0.36), and C (1.4 ± 0.67) (p ≤ 0.001). Enucleation efficiency correlated significantly with the weight of resected tissue in surgeon A (r = 0.88), B (r = 0.73), and C (r = 0.79) (p < 0.001). ThuVEP was performed by surgeon A and B with reasonable enucleation, morcellation, and overall operation efficiency after 8-16 procedures. At 12-month follow-up, 68 (71 %) patients were available for review. IPSS, QoL, Qmax, PVR, PSA, and prostate volume improved significantly at follow-up (p ≤ 0.023). Mean PSA/prostate volume reduction was 81.95/74.5, 80.7/79.4, and 87.6/75.9 % in surgeon A, B, and C, respectively. Urethral stricture and bladder neck contracture developed 2 (A = 1, B = 1; 2.1 %) patients and 1 (C, 1 %) patient each, respectively. CONCLUSIONS: ThuVEP can be performed with reasonable efficiency even during the initial learning course of the surgeon when closely mentored. Previous experience in the field of endourology is beneficial.
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ABSTRACT: To evaluate the current role of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of benign prostatic obstruction (BPO).World Journal of Urology 10/2014; DOI:10.1007/s00345-014-1417-z · 3.42 Impact Factor
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ABSTRACT: This article discusses enucleation and vaporization procedures which have been developed on the surgical techniques of holmium laser enucleation of the prostate (HoLEP) and photoselective vaporization of the prostate (PVP) by reviewing the most recent publications.
Article: Update on lasers in urology 2015[Show abstract] [Hide abstract]
ABSTRACT: Thomas R. W. HerrmannThorsten BachLasers have become a major workhorse in daily urology. Stone fragmentation, using the Ho:YAG laser, is widely accepted as the standard of intracorporal lithotripsy in ureteroscopy. Besides these well-known applications, laser treatment in surgery of LUTS due to benign prostatic obstruction has become more and more prevalent in the daily routine. Different techniques, varying from vaporization over resection to enucleation, have been described and introduced into clinical utilization. And now, laser enucleation even expands to the en-bloc removal of bladder tumours and partial nephrectomy, opening the field for even more techniques.This special edition of the World Journal of Urology is the logical consequence and update on previously published special issues on Lasers in Urology, as seen in 2007  and 2010 .Aim of this issue is to provide a comprehensive and up-to-date overview about established laser techniques such as stone fragmentation, being ...World Journal of Urology 03/2015; 33(4). DOI:10.1007/s00345-015-1534-3 · 3.42 Impact Factor