Implementing HoLEP in an Academic Department With Multiple Surgeons in Training: Mentoring Is the Key for Success
Objective Holmium laser enucleation of the prostate (HoLEP) has been recommended for the surgical management
of benign prostatic hyperplasia (BPH) in most of the international guidelines, regardless of prostatic volume. The
main advantages reported by randomized clinical studies are reduced perioperative bleeding, catheterization time,
and length of hospital stay, but this technique is also described as difficult to master with a steep learning curve.
The objective of this study was to describe the clinical outcomes of HoLEP in the real-life setting of an academic
department with multiple operators with no previous experience.
Methods A retrospective observational study was conducted including all consecutive cases performed in our
department from April 2012 to October 2020. Over the study period, 31 different operators were involved. In April
2012, 2 surgeons were trained by an experienced urologist. The 29 others learned the technique progressively with the
help of the first 2 surgeons (surgical mentoring).
Results A total of 1259 patients were included. Preoperatively, the mean prostate volume and Qmax were 82.3 g
and 9.4 mL/s, respectively. The mean operative time was 79.7 min. The intraoperative complication rate was 5.6%
(n = 71), with the need for conversion being 0.6%. Postoperatively, the complication rate was 18.6% (n = 234). Surgeon’s
experience reduced the perioperative complication rates (P = 0.01), operative time (P < 0.001), and length of hospital
stay (P < 0.001), but the difference in blood transfusion rate was statistically non-significant (P = 0.3).
Conclusions Most of the 31 urologists in training were able to master HoLEP progressively, with good functional
outcomes and acceptable complication rates. Supervision by trained urologists was critical for the safe dissemination
of the technique in our department.
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