Comparison of surgical efficacy in total en-bloc Holmium laser enucleation of the prostate: Self-learning vs. mentor-guided training

Makkati Boonma; Teerayut Tangpaitoon; Chatchawet Liwrotsap; Natthapitch Natthapitch

doi:10.52786/isu.a.117

Authors

Makkati Boonma Division of Urology, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Teerayut Tangpaitoon Division of Urology, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Chatchawet Liwrotsap Division of Urology, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Natthapitch Natthapitch Division of Urology, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

DOI:

https://doi.org/10.52786/isu.a.117

Keywords:

HoLEP, surgical training, enucleation efficiency, learning curve, urology education

Abstract

Objective: To compare the efficacy of prostate enucleation using Holmium laser (HoLEP) with total en bloc technique between urologists learning HoLEP inde- pendently versus those receiving mentorship. The aim of this study is to provide valuable insights for the optimization of surgical education.

Materials and Methods: A retrospective study was conducted at Thammasat University Hospital, Thailand, comparing the outcomes of surgery carried out by two urologists performing their first 30 HoLEP cases. One of the surgeons learned independently through online surgical videos, while the other received direct mentorship from an experienced HoLEP surgeon. The primary outcome was enucleation efficiency (EE), measured as weight of prostate tissue removed (grams) per minute of enucleation time. Secondary outcomes included perioperative complications, blood loss, catheterization time, length of hospital stay, and functional outcomes such as changes in International Prostate Symptom Score (IPSS), Qmax, and post-void residual urine (PVR).

Results: Sixty patients underwent HoLEP between 2019 and 2025, with 30 patients operated on by each surgeon. The analysis of enucleation efficiency (EE) between the two surgeons reveals notable differences in surgical performance. Across the 30 cases, a consistently higher EE value was recorded in the cases operated on by the mentor-guided surgeon suggesting a more efficient enucleation process. The analysis revealed that the mean EE in the mentor-guided surgeon group was 1.15 ± 0.44 g/minute, whereas in the patients operated on by the self-learning surgeon it was 0.71 ± 0.20 g/minute. This difference was found to be statistically significant (p < 0.001). Additionally, a higher improved Qmax of 9.2 ± 4.6 ml/sec was shown in the mentor-guided surgeon group in comparison to the cohort operated on in the self-learning group which was 12.9 ± 8.8 (p < 0.05). There was also a decrease in some of 30 day post-op complications specifically hematuria 13 (43.3%) vs 1(3.3%) (p < 0.05), capsular perforation 2 (6.7%) vs 0 (0.0%) (p < 0.05) and urinary retention 12 (40.0%) vs 0 (0.0%) (p < 0.05) in the mentor guided patients.

Conclusion: In this study it was found that mentor-guide training in HoLEP significantly enhances enucleation efficiency in comparison to self-learning. These findings highlight the importance of structured training in improving surgical proficiency and patient outcomes in HoLEP surgery.

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