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    The role of laparoscopic experience on the learning curve of HoLEP surgery: A questionnaire-based study
    (AVES, 2020-01-01) Gazel, Eymen; Kaya, Engin; Yalcin, Serdar; Tokas, Theodoros; Yilmaz, Sercan; Aybal, Halil Cagri; Aydogan, Tahsin Batuhan; Tunc, Lutfi
    Objective: Holmium laser enucleation of the prostate (HoLEP) is an established method for treating benign prostatic obstruction. Nonetheless, its steep learning curve limits its wide distribution. The purpose of the present study was to demonstrate the impact of laparoscopic experience on HoLEP learning curve by evaluating the association between learning curves of surgeons performing both laparoscopy and HOLEP surgery. Material and methods: A questionnaire was prepared to identify surgeon's experience on laparoscopy and HoLEP, as well as their learning curves. This questionnaire was then distributed via e-mail to 110 urologists who are actively involved in endourology/laparoscopy. Results: Of the 110 urologists, 80 (72.7\%) responded and completed the questionnaire. Of the 80 surgeons, 47 (58.8\%) reported that they had completed the HoLEP learning curve with <20 cases. Moreover, 33 (41.2\%) reported that they were able to complete the learning curve by performing >20 cases. Completion of the HoLEP learning curve in <20 cases was reached at 1.3\%, 13.8\%, and 43.8\% by beginner, moderate skilled, and experienced laparoscopists, respectively (p<0.001). Conclusion: Laparoscopic experience appears to be beneficial for surgeons while learning HoLEP. Highly experienced laparoscopic surgeons have a shorterHOLEP learning curve.
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    An analysis of the learning curve for robotic-assisted mitral valve repair
    (WILEY, 2021-01-01) Gullu, Ahmet U.; Senay, Sahin; Kocyigit, Muharrem; Zencirci, Ertugrul; Akyol, Ahmet; Degirmencioglu, Aleks; Karakus, Gultekin; Ersin, Egemen; Karabiber, Alara; Alhan, Cem
    Background Many cardiac surgeons receive training for sternotomy-based cardiac surgical operations in residency programs and only a few education programs offer training specifically in minimally invasive cardiac surgery. In this report, we aimed to search and analyze the learning curve for robotic-assisted mitral valve (MV) repair in cardiac surgeons. Method Between January 2010 and July 2019, 60 robotic-assisted isolated MV repair surgeries were performed with DaVinci Robotic Systems in our center. Different kinds of surgical techniques were used. The assessment of the learning curve was based on cardiopulmonary bypass (CPB) and transthoracic aortic clamp (CC) times. Result There were 23 (38.3\%) men and 37 (61.7\%) women with a mean age of 48.3 years. The lesions of the MV were posterior leaflet prolapsus (n = 42, 70.0\%), anterior leaflet prolapsus (n = 8, 13.3\%), Barlow disease (n = 3, 5\%), and annular dilatation (n = 7, 11.6\%). The patients underwent notochordal implantation (n = 27, 45\%), quadrangular or triangular resection (n = 23, 38.3\%), isolated ring annuloplasty (n = 7, 11.7\%), resection, and leaflet reduction (n = 2, 3.3\%) or edge to edge repair (n = 1, 1.7\%). The maturation of the learning curve appeared to be about 30 cases. The statistical analysis showed that the mean CPB and CC times for the first 30 cases were greater compared with the 30 after learning curve (155.3 vs. 118.9 min {[}p = .00], 102.3 vs. 80 min {[}p = .00], respectively). There was no case of conversion to open surgery. No perioperative mortality was observed. Conclusion The maturation of the learning curve for robotic-assisted MV repair appeared to be about 30 cases in our group of patients. This study had encouraging results for surgeons who desire to start a robotic mitral surgery program.