Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?
Giovanni Saredia,Giacomo Maria Pirolab*(),Francesca Ambrosinia,Simone Barbieric,Lorenzo Bertia,Andrea Pacchettid,Domenico Iovinoe,Giuseppe Iettoe,Letizia Libassie,Giulio Carcanoe
a Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy b Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy c Centro Cardiologico Monzino, IRCCS, Milan, Italy d Department of Urology, University of Genova, Genova, Italy e Department of Surgery, University of Insubria, Varese, Italy
Objective: To provide the first large single-operator case series of patients who undergo “en bloc” thulium laser enucleation of the prostate (ThuLEP) and to demonstrate an improvement in enucleation efficacy with experience. Methods: We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent “en bloc” ThuLEP between May 2015 and November 2017. Association between dependent variables (delivered energy and operating time) and independent variables (adenoma volume and experience) were estimated with regression analysis. The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered. Results: A total of 100 patients were registered for the study. Median operative time was 56.5 min (interquartile range [IQR]: 40-85 min). Median enucleation time was 17.4 min (IQR: 15-21.5 min). Median enucleation index (enucleation time per adenoma gram) was 0.3 min/g (0.2-0.3 min/g). The overall operative time is not influenced by experience, but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram (p = 0.0148). Conclusion: We believe that further attention is needed for these new “en bloc” prostatic enucleation techniques, which can facilitate some surgical steps, leading to a widespread use of laser technology for BPH surgical treatment.
. [J]. Asian Journal of Urology, 2019, 6(4): 339-345.
Giovanni Saredi,Giacomo Maria Pirola,Francesca Ambrosini,Simone Barbieri,Lorenzo Berti,Andrea Pacchetti,Domenico Iovino,Giuseppe Ietto,Letizia Libassi,Giulio Carcano. Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?. Asian Journal of Urology, 2019, 6(4): 339-345.
Lin Y, Wu X, Xu A, Ren R, Zhou X, Wen Y , et al. Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 2016; 34:1207-19.
[2]
Gravas S, Cornu JN, Drake MJ, Gacci M, Gratzke C, Herrmann TRW , et al. EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO).EAU Guidelines Office, Arnhem, The Netherlands.
[3]
Herrmann TR . Enucleation is enucleation is enucleation is enucleation. World J Urol 2016; 34:1353-5.
[4]
Scoffone CM, Cracco CM . The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World J Urol 2016; 34:1175-81.
[5]
Saredi G, Pacchetti A, Pirola GM, Berti L, Ambrosini F, Martorana E , et al. En bloc thulium laser enucleation of the prostate: surgical technique and advantages compared with the classical technique. Urology 2017; 108:207-11.
[6]
Saredi G, Pirola GM, Pacchetti A, Lovisolo JA, Borroni G, Sembenini F , et al. Evaluation of the learning curve for thulium laser enucleation of the prostate with the aid of a simulator tool but without tutoring: comparison of two surgeons with different levels of endoscopic experience. BMC Urol 2015; 15:49.
[7]
Herrmann TR, Bach T, Imkamp F, Georgiou A, Burchardt M, Oelke M , et al. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol 2010; 28:45-51.
[8]
Mamoulakis C, Efthimiou I, Kazoulis S, Christoulakis I, Sofras F . The modified Clavien classifcation system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol 2011; 29:205-10.
[9]
Netsch C, Becker B, Tiburtius C, Moritz C, Becci AV, Herrmann TRW , et al. A prospective, randomized trial comparing thulium vapoenucleation with holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic obstruction: perioperative safety and efficacy. World J Urol 2017; 35:1913-21.
[10]
Pirola GM, Saredi G, Codas Duarte R, Bernard L, Pacchetti A, Berti L , et al. Holmium laser versus thulium laser enucleation of the prostate: a matched-pair analysis from two centers. Ther Adv Urol 2018; 10:223-33.
[11]
Netsch C, Engbert A, Bach T, Gross AJ . Long-term outcome following Thulium VapoEnucleation of the prostate. World J Urol 2014; 32:1551-8.
[12]
Netsch C, Bach T, Herrmann TR, Gross AJ . Update on the current evidence for Tm:YAG vapoenucleation of the prostate 2014. World J Urol 2015; 33:517-24.
[13]
Kim YJ, Lee YH, Kwon JB, Cho SR, Kim JS . A novel one lobe technique of thulium laser enucleation of the prostate: ’Allin- One’ technique. Kor J Urol 2015; 56:769-74.
[14]
Robert G, Cornu JN, Fourmarier M, Saussine C, Descazeaud A, Azzouzi AR , et al. Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int 2016; 117:495-9.
[15]
Shah HN, Mahajan AP, Sodha HS, Hegde S, Mohile PD, Bansal MB . Prospective evaluation of the learning curve for holmium laser enucleation of the prostate. J Urol 2007; 177:1468-74.
[16]
Brunckhorst O, Ahmed K, Nehikhare O, Marra G, Challacombe B, Popert R . Evaluation of the learning curve for holmium laser enucleation of the prostate using multiple outcome measures. Urology 2015; 86:824-9.
[17]
Peyronnet B, Robert G, Comat V, Roupr$\widehat{e}$t M, Gomez-Sancha F, Cornu JN , et al. Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World J Urol 2017; 35:973-83.
[18]
Hirasawa Y, Kato Y, Fujita K . Transurethral enucleation with bipolar for benign prostatic hyperplasia: 2-year outcomes and the learning curve of a single surgeon’s experience of 603 consecutive patients. J Endourol 2017; 31:679-85.
[19]
Herrmann T, Kallidonis P, Kotsiris D, Kyriazis I, Ntasiotis P, Kamal W , et al. Surgeons’ self-assessed learning curve for thulium-assisted laser prostatectomy: evaluation of a nationwide survey. Hellenic Urology 2017; 29:46-53.
