Evaluation of the learning curve for transurethral plasmakinetic enucleation and resection of prostate using a mentor-based approach

Abstract

Objective To analyze the mentor-based learning curve of one single surgeon with transurethral plasmakinetic enucleation and resection of prostate (PKERP) prospectively.Materials and Methods Ninety consecutive PKERP operations performed by one resident under the supervision of an experienced endourologist were studied. Operations were analyzed in cohorts of 10 cases to determine when a plateau was reached for the variables such as operation efficiency, enucleation efficiency and frequency of mentor advice (FMA). Patient demographic variables, perioperative data, complications and 12-month follow-up data were analyzed and compared with the results of a senior urologist.Results The mean operative efficiency and enucleation efficiency increased from a mean of 0.49±0.09g/min and 1.11±0.28g/min for the first 10 procedures to a mean of 0.63±0.08g/min and 1.62±0.36g/min for case numbers 31-40 (p=0.003 and p=0.002). The mean value of FMA decreased from a mean of 6.7±1.5 for the first 10 procedures to a mean of 2.8±1.2 for case numbers 31-40 (p<0.01). The senior urologist had a mean operative efficiency and enucleation efficiency equivalent to those of the senior resident after 40 cases. There was significant improvement in 3, 6 and 12 month’s parameter compared with preoperative values (p<0.001).Conclusions PKERP can be performed safely and efficiently even during the initial learning curve of the surgeon when closely mentored. Further well-designed trials with several surgeons are needed to confirm the results.

Is the Peripheral Zone Thickness an Indicator of a Learning Curve in Bipolar Transurethral Plasma Enucleation of the Prostate?—A Single Center Cohort Study

“…As BPH develops, the proliferation of the transitional zone has compression effects on urethra, peripheral zone, bladder, and surrounding tissue (1), thereby causing urinary tract obstruction and thinning of peripheral zone and intravesical prostatic protrusion (IPP). However, the compression effect on the peripheral zone could be low when the prostate volume is small, resulting in the lack of a well-defined mature layer formation that is crucial to identify surgical plane during enucleation (19). The result of our study indicates PZT may become thinner under pressure with the increase of age and the aggravation of BPH, due to the fact that patients in the Medium group are older than those in the Thick group.…”

“…Our study was based on the learning process of Surgeon A, which may lack representativeness. We noticed that there are also some published studies that involved just a single surgeon (17,19), and we consider it is valuable to share this experience with more surgeons who want to learn B-TUEP.…”

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder

“…18 Similarly, Feng et al analyzed the learning curve of one single surgeon with transurethral plasmakinetic enucleation/resection of prostate and found excellent safety and efficiency even at the beginning of the learning curve of the surgeon. 19 Interestingly, learning curves in urogynecology are often based on performances of a single operator, thus limiting the generalization of the data. 20,21 Moreover, often studies assessing the learning curve in cystoscopy are based on training on virtual simulators.…”

“… 18 Similarly, Feng et al analyzed the learning curve of one single surgeon with transurethral plasmakinetic enucleation/resection of prostate and found excellent safety and efficiency even at the beginning of the learning curve of the surgeon. 19 …”

Surgical training for anatomical endoscopic enucleation of the prostate

“…However, in AEEP, one small mistake can lead to disastrous outcomes, so the mentor should still be present in the initial cases and be ready to take over in case of loss of orientation of enucleation plane (Netsch et al., 2013). A mentor‐based approach has been shown to be successful to help urologists learn and adopt AEEP in their clinical practices (Enikeev et al., 2018; Feng, Song, Zhang, & Tian, 2017; Netsch et al., 2013; Shin et al., 2018).…”