Dmitry Enikeev1, Andrey Morozov2, Mark Taratkin2, Vincent Misrai3, Enrique Rijo4, Alexei Podoinitsin5, Svetlana Gabdullina6, Thomas R W Herrmann7,8. 1. Institute for Urology and Reproductive Health, Sechenov University, 2/1, Bolshaya Pirogovskaya str, Moscow, 119991, Russia. dvenikeev@gmail.com. 2. Institute for Urology and Reproductive Health, Sechenov University, 2/1, Bolshaya Pirogovskaya str, Moscow, 119991, Russia. 3. Department of Urology, Clinique Pasteur, Toulouse, France. 4. Department of Urology, Hospital Quirón Salud, Barcelona, Spain. 5. Moscow Regional Research and Clinical Institute Moniki N.a. M.F. Vladimirskiy, Moscow, Russia. 6. Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia. 7. Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland. 8. Department of Urology, Hannover Medical School, Hannover, Germany.
Abstract
INTRODUCTION: It has been shown that endoscopic enucleation of the prostate (EEP) allows for similar efficacy and safety, no matter what energy and type of instruments we use, but the length of learning may differ greatly. The aim of this systematic review is to verify if there is any significant difference between EEP methods in learning. EVIDENCE ACQUISITION: We performed a systematic literature search in three databases and included only the articles containing their own data on the EEP learning curve assessment during the last 10 years. The primary endpoint was to determine the necessary experience needed to achieve a plateau. The secondary endpoints were to review methods used to evaluate a learning curve. EVIDENCE SYNTHESIS: The final sample included 17 articles, containing a total of 4615 EEPs performed by 76 surgeons, the most common method was HoLEP (9/17). The majority of articles studying HoLEP report a learning curve of experience level achievement in roughly 30-40 (min 20; max 60) cases. The studies of GreenLight laser showed high heterogeneity in the results with minimum of 20 cases and maximum of 150-200 cases. TUEB required roughly 40-50 cases to reach the plateau. CONCLUSION: Although EEP is considered challenging, it shows a steep learning curve with a plateau after 30-50 cases. Proper criteria are critical for accurate assessment of the learning curve. The Trifecta and Pentafecta criteria are currently the most appropriate method to evaluate EEP learning.
INTRODUCTION: It has been shown that endoscopic enucleation of the prostate (EEP) allows for similar efficacy and safety, no matter what energy and type of instruments we use, but the length of learning may differ greatly. The aim of this systematic review is to verify if there is any significant difference between EEP methods in learning. EVIDENCE ACQUISITION: We performed a systematic literature search in three databases and included only the articles containing their own data on the EEP learning curve assessment during the last 10 years. The primary endpoint was to determine the necessary experience needed to achieve a plateau. The secondary endpoints were to review methods used to evaluate a learning curve. EVIDENCE SYNTHESIS: The final sample included 17 articles, containing a total of 4615 EEPs performed by 76 surgeons, the most common method was HoLEP (9/17). The majority of articles studying HoLEP report a learning curve of experience level achievement in roughly 30-40 (min 20; max 60) cases. The studies of GreenLight laser showed high heterogeneity in the results with minimum of 20 cases and maximum of 150-200 cases. TUEB required roughly 40-50 cases to reach the plateau. CONCLUSION: Although EEP is considered challenging, it shows a steep learning curve with a plateau after 30-50 cases. Proper criteria are critical for accurate assessment of the learning curve. The Trifecta and Pentafecta criteria are currently the most appropriate method to evaluate EEP learning.
Authors: Usha S Govindarajulu; Marco Stillo; David Goldfarb; Michael E Matheny; Frederic S Resnic Journal: Stat Med Date: 2017-05-03 Impact factor: 2.373
Authors: Richard Naspro; Fernando Gomez Sancha; Michele Manica; Agostino Meneghini; Sascha Ahyai; Tevita Aho; Cristian Fiori; Ivano Vavassori; Luigi F DA Pozzo; Vito Pansadoro; Francesco Montorsi; Thomas R Herrmann Journal: Minerva Urol Nefrol Date: 2017-02-01 Impact factor: 3.720
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