New Surgical Instruction Method for Homium Laser Enucleation of the Prostate, “Hand-Grab Navigated Technique,” to Shorten the Learning Curve: The Results of Multicenter Analysis

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Abstract

Objectives:

To introduce a new surgical mentorship, the “hand-grab navigated technique,” to shorten the learning curve for Holmium laser enucleation of the prostate.

Methods:

Patients with benign prostatic hyperplasia were managed at six institutions with Holmium laser enucleation of the prostate. An analysis was done in the 200 of these patients (the set of first 20 patients treated with Holmium laser enucleation of the prostate by 10 surgeons) who were sorted into two groups depending on the surgeon's instructional group. Surgeons in group I learned Holmium laser enucleation of the prostate by self-study by using videos and written information, whereas those in group II were instructed by “the hand-grab navigated technique” along with the self-study. To evaluate the efficiency of hand-grab navigated technique, enucleation and morcellation efficiencies between the two groups were compared.

Results:

The mean prostate volume was 49.5 ± 23.8 and 51.1 ± 25.2 g in group I and II, respectively, showing no significant difference. The enucleation efficiency was significantly greater (P= 0.01) in group II (0.35 ± 0.20 g/min) than in group I (0.21 ± 0.12 g/min). Morcellation efficiency was also significantly greater (P= 0.03) in group II (3.08 ± 3.27 g/min) than in group I (2.43 ± 2.68 g/min).

Conclusion:

The learning curve for Holmium laser enucleation of the prostate can be shortened with the “hand-grab navigated technique” when combined with the self-study.

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