Switching Lasers: Assessing the learning curves of surgeons with di7erent surgical experience when switching from HoLEP to pulsed Thulium YAG lasers for ThuLEP - Report - MDSpire
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Switching Lasers: Assessing the learning curves of surgeons with di7erent surgical experience when switching from HoLEP to pulsed Thulium YAG lasers for ThuLEP
Learning Curves for Surgeons Transitioning from HoLEP to Pulsed Thulium YAG ThuLEP
Overview
This study evaluated the learning curves of three surgeons with varying HoLEP experience transitioning to pulsed Thulium laser enucleation of the prostate (ThuLEP). Experienced surgeons achieved proficiency faster and used less laser energy, while a novice surgeon successfully completed training within a structured program, demonstrating safety and feasibility.
Background
Benign prostatic enlargement (BPE) commonly causes lower urinary tract symptoms (LUTS) in aging men. Surgical options like Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation (ThuLEP) have become established treatments. Despite their efficacy, steep learning curves and equipment costs limit widespread adoption. Pulsed Thulium:YAG lasers represent a novel technology with promising energy delivery characteristics, but data on surgeon transition from HoLEP to pulsed ThuLEP are lacking.
Data Highlights
Surgeon Experience Level
Prior HoLEP Cases
Proficiency Achievement Speed
Laser Energy Used (kJ)
Enucleation Efficiency (g/min)
Enucleation Time (min)
Highly Experienced
>1,000
Fastest (approx. twice as fast as moderate)
Lowest (about half that of others)
Reached plateau quickly
Reached plateau quickly
Moderately Experienced
>200
Intermediate
Higher than highly experienced
Reached plateau slower than highly experienced
Reached plateau slower than highly experienced
Novice (No prior HoLEP)
0
Slowest, but feasible with training
Not specified
Improved with structured training
Improved with structured training
Key Findings
Surgeons with prior HoLEP experience reached proficiency in pulsed ThuLEP approximately twice as fast as those with moderate experience.
Highly experienced surgeons required about half the laser energy compared to less experienced surgeons.
Enucleation efficiency and time plateaued faster in surgeons with prior HoLEP experience.
A novice surgeon without HoLEP experience successfully completed a structured training program and performed ThuLEP safely and effectively.
Postoperative functional outcomes were comparable across all experience levels.
Switching from HoLEP to pulsed ThuLEP is safe and feasible for experienced surgeons.
Clinical Implications
Surgeons experienced in HoLEP can transition to pulsed ThuLEP efficiently, achieving proficiency faster and using less laser energy, which may optimize operative efficiency. Structured training programs enable novice surgeons without prior HoLEP experience to safely adopt pulsed ThuLEP, supporting broader implementation of this technology. These findings support the safe integration of pulsed Thulium laser systems into clinical practice for BPE treatment.
Conclusion
Pulsed ThuLEP demonstrates a learning curve comparable to HoLEP when performed within a structured training framework. Experienced HoLEP surgeons can safely and effectively switch to pulsed Thulium laser systems, while novices can achieve proficiency through guided training.
References
Westhofen et al. 2024 -- Structured Training Program for ThuLEP
Uleri et al. -- Systematic Review of Laser Platforms in Prostate Surgery
EAU Guidelines 2023 -- Management of Non-Neurogenic Male LUTS
by Stadelmeier, Leo Federico, Berger, Laurenz , Nicola, Philip , Weinhold, Philipp , Marcon, Julian , Atzler, Michael , Volz, Yannic , Pyrgidis, Nikolaos , Papadopoulos, Iason , Hennenberg, Martin , Stief, Christian Georg, Keller, Patrick M., Tamalunas, Alexander
