Holmium Laser Enucleation Of The Prostate (HOLEP) Learning Curve - Resident Perspective: Survey Of Senior Residents From High-Volume Tertiary Center.

OBJECTIVE: We aim to report the learning curve and experience performing holmium laser enucleation of the prostate (HOLEP) from a resident standpoint trained at a tertiary high-volume center.

METHODS: An electronic survey was distributed to ten surveyees that included recently graduated chief residents trained at Indiana University in the last 3 years i.e. between 2020-2022 with a 100% response rate. The questionnaire focused on HOLEP training experience based on a recently established mentorship curriculum in training the residents through each individual step of the surgery.

RESULTS: The average learning curve for performing HOLEP was reported to be greater than 25 cases with 50% of the residents reporting >50 cases to master the technique. The surgical difficulty of steps of the HOLEP were rated on a subjective scale of 1-5: 1 = very easy, 2 = easy, 3= neutral, 4 = hard, and 5 = very hard. The common challenging steps in decreasing the order of difficulty as reported are performing apical enucleation, joining anterior and posterior planes, and dividing anterior commissure with a mean rating of 3.5, 3.1, and 3.1 respectively. The most difficult aspect of the surgery to master was performing apical dissection (60%). Comparing operative parameters for HOLEP to transurethral resection of the prostate (TURP) in aspects of resection volume and times, 70 % of candidates reported it better for HOLEP whereas 20% had similar times for both procedures. 90 % of the residents felt confident to offer HOLEP as part of their practice without the need for any further training.

CONCLUSION: We believe HOLEP can be performed immediately after residency training and incorporated into practice with high volume, repeated exposure to HoLEP surgery throughout residency based on study results. The average learning curve reported for performing HOLEP was greater than 25 case.