{"title":"Learning curve analysis of transurethral thulium fiber laser enucleation of the prostate with preserving urethral Mucosa at the prostatic apex.","authors":"Dawei Xie, Yirui Wei, Weifeng He, Hao Wang, Pushen Yang, Liyang Wu, Jianwen Wang","doi":"10.3389/fsurg.2025.1646928","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To introduce a unique surgical technique, analyze perioperative data to demonstrate the safety of Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) with preservation of the urethral mucosa at the prostatic apex, and construct a learning curve to assess its feasibility and potential for broader clinical application is the aim of this study.</p><p><strong>Methods: </strong>From June 2020 to June 2024, a urologist at Beijing Chaoyang Hospital, with no prior ThuFLEP experience, was trained under the supervision of an experienced chief physician. A retrospective analysis of 100 Benign Prostatic Hyperplasia (BPH) patients treated with ThuFLEP was conducted. Perioperative data were analyzed, including prostate volume, operative time, and enucleation weight. Statistical methods included <i>T</i>-tests, chi-square tests, and linear regression. Learning curves were constructed using Loess regression, with box plots visualizing differences in operative time, efficiency, and enucleation ratio efficacy. Postoperative follow-up assessed changes in IPSS, Qmax, and urinary incontinence.</p><p><strong>Results: </strong>The learning curve analysis showed a significant reduction in operative time after 56 cases. Linear regression indicated a decrease in operative time (<i>R</i> = -0.5, <i>p</i> < 0.01) and improvements in efficiency (<i>R</i> = 0.14, <i>p</i> < 0.01) and enucleation ratio efficacy (<i>R</i> = 0.41, <i>p</i> < 0.01) with increased experience. Comparing the first and last 50 cases, operative time and enucleation efficiency significantly improved (<i>p</i> < 0.01). Postoperatively, 31% of patients experienced incontinence one week after catheter removal, but all recovered within 12 weeks. IPSS scores improved by 13.67 ± 3.99 points.</p><p><strong>Conclusions: </strong>ThuFLEP with urethral mucosa preservation improves efficiency, reduces operative time, and has a manageable learning curve. Attention to complications and structured mentorship are crucial for successful implementation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1646928"},"PeriodicalIF":1.6000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479399/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2025.1646928","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To introduce a unique surgical technique, analyze perioperative data to demonstrate the safety of Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) with preservation of the urethral mucosa at the prostatic apex, and construct a learning curve to assess its feasibility and potential for broader clinical application is the aim of this study.
Methods: From June 2020 to June 2024, a urologist at Beijing Chaoyang Hospital, with no prior ThuFLEP experience, was trained under the supervision of an experienced chief physician. A retrospective analysis of 100 Benign Prostatic Hyperplasia (BPH) patients treated with ThuFLEP was conducted. Perioperative data were analyzed, including prostate volume, operative time, and enucleation weight. Statistical methods included T-tests, chi-square tests, and linear regression. Learning curves were constructed using Loess regression, with box plots visualizing differences in operative time, efficiency, and enucleation ratio efficacy. Postoperative follow-up assessed changes in IPSS, Qmax, and urinary incontinence.
Results: The learning curve analysis showed a significant reduction in operative time after 56 cases. Linear regression indicated a decrease in operative time (R = -0.5, p < 0.01) and improvements in efficiency (R = 0.14, p < 0.01) and enucleation ratio efficacy (R = 0.41, p < 0.01) with increased experience. Comparing the first and last 50 cases, operative time and enucleation efficiency significantly improved (p < 0.01). Postoperatively, 31% of patients experienced incontinence one week after catheter removal, but all recovered within 12 weeks. IPSS scores improved by 13.67 ± 3.99 points.
Conclusions: ThuFLEP with urethral mucosa preservation improves efficiency, reduces operative time, and has a manageable learning curve. Attention to complications and structured mentorship are crucial for successful implementation.
目的：介绍一种独特的手术技术，分析围手术期数据，证明保留前列腺尖部尿道粘膜的铥光纤激光前列腺去核术（ThuFLEP）的安全性，并构建学习曲线，评估其可行性和更广泛的临床应用潜力。方法：2020年6月至2024年6月，北京朝阳医院泌尿科医师在一名经验丰富的主任医师的指导下，对一名没有ThuFLEP经验的泌尿科医师进行培训。回顾性分析了100例应用ThuFLEP治疗的良性前列腺增生（BPH）患者。分析围手术期数据，包括前列腺体积、手术时间和去核重量。统计方法包括t检验、卡方检验和线性回归。使用黄土回归构建学习曲线，用箱形图显示手术时间、效率和去核率疗效的差异。术后随访评估IPSS、Qmax和尿失禁的变化。结果：经学习曲线分析，56例术后手术时间明显缩短。线性回归结果显示手术时间缩短（R = -0.5, p R = 0.14, p R = 0.41, p p）。结论：尿道粘膜保留术可提高手术效率，缩短手术时间，学习曲线可控。注意复杂性和有组织的指导是成功实施的关键。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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