The Surgical Experience Influences the Safety and Efficacy of Photovaporization of Prostate with 180-W XPS GreenLight Laser: Comparison Between Novices <i>vs</i> Expert Surgeons Learning Curves

Castellan, Pietro; Marchioni, Michele; Rizzoli, Ambra; Nicola, Marta Di; Porfilio, Italo; Ghahhari, Jamil; Greco, Francesco; Schips, Luigi; Cindolo, Luca

doi:10.1089/end.2018.0437

Cited by 9 publications

(6 citation statements)

References 26 publications

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“…According to a recent study by Castellan et al . that analyzed a learning curve of PVP using the 180 W XPS laser, surgeons with greater experience in endoscopic procedure showed a lower rate of early complications and greater evolution in lasing time/operation time ratio than those with lesser experience 23 . However, there was no significant difference in the functional outcomes at 6 months after surgery between the groups 23 .…”

Section: Discussionmentioning

confidence: 99%

“…that analyzed a learning curve of PVP using the 180 W XPS laser, surgeons with greater experience in endoscopic procedure showed a lower rate of early complications and greater evolution in lasing time/operation time ratio than those with lesser experience 23 . However, there was no significant difference in the functional outcomes at 6 months after surgery between the groups 23 . In the present study, when the learning curve for the efficiency of PVP was assessed by the ratio of the removed prostate volume/operation time, the PVP efficiency seemed to be stationary even in the first case.…”

Section: Discussionmentioning

confidence: 99%

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Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

Sun

Yoo

Park

et al. 2019

Sci Rep

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This study was aimed to compare serial long-term postoperative changes in quality-of-life (QoL) between photoselective-vaporization (PVP) using 120W-High-Performance-System and holmium-laser-enucleation (HoLEP) in benign-prostatic-hyperplasia (BPH) patients and to identify factors influencing the QoL improvement at the short-term, mid-term and long-term follow-up visits after surgery. We analyzed 1,193 patients with a baseline QoL-index ≥2 who underwent PVP (n = 439) or HoLEP (n = 754). Surgical outcomes were serially compared between the two groups at up to 60-months using the International-Prostatic-Symptom-Score (I-PSS), uroflowmetry, and serum PSA. We used logistic regression analysis to identify predictors of QoL improvement (a reduction in the QoL-index ≥50% compared with baseline) at the short-term (12-months), mid-term (36-months), and long term (60-months) follow-up after surgery. In both groups, the QoL-index was decreased throughout the entire follow-up period compared with that at baseline. There were no significant differences in postoperative changes from the baseline QoL-index between the two groups during the 48-month follow-up, except at 60-months. The degree of improvement in QoL at 60-months after HoLEP was greater than that after PVP. A lower baseline storage-symptom-subscore and a higher bladder-outlet-obstruction-index (BOOI) were independent factors influencing QoL improvement at the short-term. No independent factor influences QoL improvement at the mid- or long-term.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

Sun

Yoo

Park

et al. 2019

Sci Rep

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“…Furthermore, our analysis demonstrated that patients operated by less-experienced surgeons may expect a higher risk of reoperation for larger adenomas. Studies have previously shown that novice surgeons perform less efficiently in terms of energy delivered per volume of the prostate, vaporization time/operative time ratio, and postoperative complications [ 9 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical reintervention requirements following GreenLight PVP: A single-center experience using three different laser device models

Özveren

Karşıyakalı

Türkeri

2023

Arab Journal of Urology

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Objective To assess the incidence, risk factors, and timing of specific causes of reoperations following PVP. Material and Methods A retrospective analysis of data on men who underwent GreenLight PVP between 2004 and 2019 in a single center and required surgical intervention for bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma. Results The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter. None of the risk factors had any relevance to US. In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor. In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations ( p < 0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis. Conclusions An unselective utilization of PVP may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons.

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“…Interestingly, Castellan et al. assessed the extent to which surgical experience can affect perioperative and functional outcomes after PVP with the 180‐W XPS GreenLight laser. They compared two groups of patients operated on by expert and novice surgeons and showed that surgeons’ background and expertise appeared to affect outcomes over the LC, with roughly similar perioperative and functional results.…”

Section: Discussionmentioning

confidence: 99%

The surgical learning curve for endoscopic GreenLight™ laser enucleation of the prostate: an international multicentre study

et al. 2019

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Objectives To investigate the effect of surgical experience on the perioperative outcomes of endoscopic GreenLight™ (Boston Scientific Corporation, Marlborough, MA, USA) laser enucleation of the prostate (GreenLEP). Subjects/Patients and Methods A multicentre retrospective study of the first patients treated with GreenLEP by six surgeons was conducted. For each patient, surgical experience was coded as the total number of procedures performed by the surgeons before the patient's operation. The learning curve was analysed in terms of changes over time for the following variables: enucleation time, morcellation time, occurrence of intraoperative complications (IOCs), 3‐month postoperative International Prostate Symptom Score (IPSS) reduction, and the rate of Pentafecta achievement. Results In total, 922 patients were analysed. At multivariable regression analyses adjusted for case mix, surgical experience was associated with shorter enucleation and morcellation time (P < 0.001), lower IOC rate (P < 0.001), higher 3‐month postoperative reduction in IPSS (P = 0.004), and higher probability of Pentafecta achievement (P < 0.001). The relationship between surgical experience and enucleation time/IOCs appeared as non‐linear, with a steep slope reduction within the first 100 cases and a plateau observed after 200 cases, whilst the IPSS improved rapidly early in the learning curve process and plateaued after ~100 procedures. Finally, there was a linear improvement in Pentafecta achievement, with a plateau observed after 270 cases. Conclusion Surgical experience has a significant impact on the perioperative outcomes for GreenLEP procedures. After adjusting for patient and prostate characteristics, plateau results were achieved after a long learning curve. A more intensely mentored and structured training schedule might allow quicker and safer adoption of the procedure.

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The Surgical Experience Influences the Safety and Efficacy of Photovaporization of Prostate with 180-W XPS GreenLight Laser: Comparison Between Novices vs Expert Surgeons Learning Curves

Abstract: Surgeons' background and expertise appear to affect outcomes over the learning curve, with roughly similar perioperative and functional results.

Cited by 9 publications

References 26 publications

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

Surgical reintervention requirements following GreenLight PVP: A single-center experience using three different laser device models

The surgical learning curve for endoscopic GreenLight™ laser enucleation of the prostate: an international multicentre study

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