Evaluation of the learning curve for transurethral plasmakinetic enucleation and resection of prostate using a mentor-based approach

OBJECTIVE: To analyze the mentor-based learning curve of one single surgeon with transurethral plasmakinetic enucleation and resection of prostate (PKERP) prospectively. MATERIALS AND METHODS: Ninety consecutive PKERP operations performed by one resident under the supervision of an experienced endourologist were studied. Operations were analyzed in cohorts of 10 cases to determine when a plateau was reached for the variables such as operation efficiency, enucleation efficiency and frequency of mentor advice (FMA). Patient demographic variables, perioperative data, complications and 12-month follow-up data were analyzed and compared with the results of a senior urologist. RESULTS: The mean operative efficiency and enucleation efficiency increased from a mean of 0.49±0.09g/min and 1.11±0.28g/min for the first 10 procedures to a mean of 0.63±0.08g/min and 1.62±0.36g/min for case numbers 31-40 (p=0.003 and p=0.002). The mean value of FMA decreased from a mean of 6.7±1.5 for the first 10 procedures to a mean of 2.8±1.2 for case numbers 31-40 (p<0.01). The senior urologist had a mean operative efficiency and enucleation efficiency equivalent to those of the senior resident after 40 cases. There was significant improvement in 3, 6 and 12 month’s parameter compared with preoperative values (p<0.001). CONCLUSIONS: PKERP can be performed safely and efficiently even during the initial learning curve of the surgeon when closely mentored. Further well-designed trials with several surgeons are needed to confirm the results.