Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate.

PURPOSE: To appraise the evaluation methods for learning curve and to analyze the non-mentor-aided learning curve and early complications following the holmium laser enucleation of the prostate. MATERIALS AND METHODS: One-hundred and forty (n=140) consecutive patients who underwent HoLEP from July 2008 to July 2010 by a single surgeon (SJO) were enrolled. Perioperative clinical variables, including enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), enucleation efficacy (enucleated weight/enucleation time), enucleation ratio efficacy (enucleation ratio/enucleation time), and early complication rate were analyzed. RESULTS: Mean prostate volume was 62.7 mL (range 21-162) and preoperative International Prostate Symptom Score (IPSS) was 19.0 (4-35). Mean enucleation time and morcellation time were 49.9 ± 23.8 (S.D.) min and 11.0 ± 9.7 min, respectively. Median duration of postoperative indwelling catheter was 1 (1-7) day and median hospital stay was 1 (1-6) day. There were a total of 31 surgery-related complications in 27 patients (19.3%), and all were manageable. There was an increasing trend of enucleation efficacy in the first 50 cases. However, enucleation efficacy was linearly correlated with the prostate size (correlation coefficients, R=0.701, p<0.001). But, enucleation ratio efficacy could eliminate the confounding effect of the prostate size (R=-0.101, p=0.233). The plateau of enucleation ratio efficacy was reached around the twenty-fifth case. CONCLUSIONS: Our results demonstrated that the operative learning curve plateau is reached after about 25 cases. We propose that a more appropriate parameter for estimating the operative learning curve is enucleation ratio efficacy, rather than enucleation efficacy.

Transvaginal and transrectal natural orifice translumenal endoscopic surgery nephrectomy in a porcine survival model: comparison with conventional laparoscopic nephrectomy.

PURPOSE: We analyzed the technical feasibility, physiological influence, and safety of transvaginal (TV) and transrectal (TR) natural orifice translumenal endoscopic surgery (NOTES) nephrectomy compared with conventional laparoscopic surgery in a porcine survival model. METHODS: Fifteen female pigs (32.8-37.2 kg) were randomly assigned to undergo TV NOTES (n=5), TR NOTES (n=5), or conventional laparoscopic nephrectomy (n=5). Postoperatively, all animals were observed for global health status during the recovery from anesthesia. Variable laboratory parameters and inflammatory cytokines were compared among the groups during the entire experimental period. Postmortem examination was performed 1 week after operation for assessment of abdominal complications and cultures for microorganisms. RESULTS: All experiments were completed successfully without insertion of an extra port or conversion to laparoscopic or open surgery. Although mean operative times were longer in TV and TR NOTES groups than in the conventional laparoscopy group (61 vs 84 vs 24 min, P<0.001), there were no signs of visceral injury or peritonitis on postmortem examination. None of the laboratory parameters, including white blood cell count, tumor necrosis factor-α, interleukin (IL)-1, and IL-6 differed among the groups during the entire experimental period. CONCLUSIONS: TV and TR NOTES nephrectomy could be completed successfully with similar physiologic influence to those of conventional laparoscopic nephrectomy in a porcine survival model.

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

PURPOSE: To appraise the evaluation methods for learning curve and to analyze the non-mentor-aided learning curve and early complications following the holmium laser enucleation of the prostate. MATERIALS AND METHODS:One-hundred and forty (n=140) consecutive patients who underwent HoLEP from July 2008 to July 2010 by a single surgeon (SJO) were enrolled. Perioperative clinical variables, including enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), enucleation efficacy (enucleated weight/enucleation time), enucleation ratio efficacy (enucleation ratio/enucleation time), and early complication rate were analyzed. RESULTS: Mean prostate volume was 62.7 mL (range 21-162) and preoperative International Prostate Symptom Score (IPSS) was 19.0 (4-35). Mean enucleation time and morcellation time were 49.9±23.8 (S.D.) min and 11.0±9.7 min, respectively. Median duration of postoperative indwelling catheter was 1 (1-7) day and median hospital stay was 1 (1-6) day. There were a total of 31 surgery-related complications in 27 patients (19.3%), and all were manageable. There was an increasing trend of enucleation efficacy in the first 50 cases. However, enucleation efficacy was linearly correlated with the prostate size (correlation coefficients, R=0.701, p<0.001). But, enucleation ratio efficacy could eliminate the confounding effect of the prostate size (R=-0.101, p=0.233). The plateau of enucleation ratio efficacy was reached around the twenty-fifth case. CONCLUSIONS: Our results demonstrated that the operative learning curve plateau is reached after about 25 cases. We propose that a more appropriate parameter for estimating the operative learning curve is enucleation ratio efficacy, rather than enucleation efficacy.