The role of laparoscopic experience on the learning curve of HoLEP surgery: A questionnaire-based study

Abstract

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.