Presentation Authors: Zine-Eddine KHENE*, Benoit Peyronnet, Sébastien Vincendeau, Romain Huet, Romain Mathieu, Rennes, France, Enrique Enrique, Barcelona, Spain, Fernando Gomez-Sancha, Madrid, Spain, Vincent Misrai, Toulouse, France
Introduction: The number of cases needed to become proficient in Green Light endoscopic enucleation of the prostate (GreenLEP) is the subject of continuous debate. The aim of this study was to investigate the effect of surgical experience (EXP) on perioperative parameters to estimate the learning curve for GreenLEP.
Methods: The cohort study included 922 patients with lower urinary tract symptoms due to BPO and treated with GreenLEP by expertsâ€™ surgeons from four European institutions between 2013 and 2018. For each patient, surgeon experience was coded as the total number of procedures performed by surgeons before the patientâ€™s operation. Multivariable models were used to assess the association between surgeon experience and total operative time (OT), occurrence of intraoperative complications (IOC) and Pentafecta achievement with adjustment for established predictors.
Results: Median OT was 64 min. The rate of IOC and Pentafecta achievement was 5% and 64%, respectively. At multivariable regression analyses adjusted for case mix, EXP resulted associated with shorter OT (p < 0.0001), lower intraoperative complications rate (p = 0.001) and higher probability of pentafecta achievement (p = 0.001). The relationship between EXP and OT/IOC appeared as nonlinear, with a steep slope reduction within the first 100 cases and a plateau observed after 200 cases. Conversely, the relationship between EXP and Pentafecta achivement resulted linear, with reaching a plateau phase at the 270 cases.
Conclusions: Increasing surgical experience is associated with substantial improvement in perioperative outcomes after GreenLEP. After 200 cases, no further improvement is observed with respect to OT and the occurrence of intraoperative complications, but the learning curve appears continue with respect to Pentafecta achievement until the 270 cases.