Abstract
Objective
To evaluate the opinion of Holmium laser enucleation of the prostate (HoLEP)-naïve
urologists about a surgical simulator and the level of difficulty at each step.
Materials and Methods
We evaluated 40 HoLEP-naïve urologists in a course involving 4 steps: lecture introducing
Holmium laser basics and technique; live surgery; video explaining prostate enucleation
using simulators; and simulator trial. A survey was applied to evaluate content validity
and face validity of the simulator. Subjects also ranked the level of difficulty of
each surgical step.
Results
All urologists agreed on the importance of a validated HoLEP simulator in training;
95% agreed that simulation-based training is essential for patient safety. The mean
rate of face validity of all analyzed components was 8.4 (8.1-9.0). Instrumentation
was considered the most realistic component, followed by laser-tissue interaction.
Positioning the fiber and bladder neck incisions (BNIs) at 5 and 7-o'clock were the
easiest steps. Detaching the median lobe from the bladder neck, BNI at 12, dividing
the mucosal bridge distally, and joining the upper and lower incisions were the most
difficult steps. Residents found more difficulty in joining the BNIs distally (3.6
vs 2.4, P = .006) and in dividing the mucosal bridge distally (4.0 vs 3.0, P = .038) when compared to specialists.
Conclusion
HoLEP-naïve urologists found this simulator useful and important for patient safety.
Most components were considered realistic. Simulation was able to reproduce the levels
of difficulty usually found in real life cases. The level of expertise may influence
the learning process of some steps.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction.Eur Urol. 2013; 64: 118-140
- Enucleation is enucleation is enucleation is enucleation.World J Urol. 2016; 34: 1353-1355
- Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years.BJU Int. 2012; 109: 408-411
- A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update.Eur Urol. 2015; 67: 1066-1096
- Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP).BJU Int. 2016; 117: 495-499
- The learning curve for holmium laser enucleation of the prostate: a single-center experience.Korean J Urol. 2010; 51: 688-693
- Evaluation of the learning curve for holmium laser enucleation of the prostate using multiple outcome measures.Urology. 2015; 86: 824-829
- Effectiveness of learning holmium laser enucleation of the prostate in a virtual reality simulation environment: a validation study.BJU Int. 2014; 113: 34
- Face and content validation of the prostatic hyperplasia model and holmium laser surgery simulator.J Surg Educ. 2014; 71: 339-344
- Description of a modular mentorship programme for holmium laser enucleation of the prostate.World J Urol. 2015; 33: 497-502
- The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique.World J Urol. 2016; 34: 1175-1181
- Holmium laser enucleation of the prostate.J Endourol. 2018; 32: S7-S9
- Holmium laser enucleation of the prostate (HoLEP).BJU Int. 2008; 101: 131-142
- Risk factors for male lower urinary tract symptoms: the role of metabolic syndrome and androgenetic alopecia in a Latin American population.Urology. 2013; 82: 182-188
- Safety, perioperative, and early functional outcomes of vapor incision technique using the GreenLight XPS 180 W system: direct comparison with photoselective vaporization of the prostate.J Endourol. 2017; 31: 43-49
- GreenLight™ laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study.J Urol. 2015; 193: 927-934
- Impact of laparoscopic surgery training laboratory on surgeon's performance.World J Gastrointest Surg. 2016; 8: 735-743https://doi.org/10.4240/wjgs.v8.i11.735
- Does prostate morphology affect outcomes after holmium laser enucleation?.Urology. 2013; 81: 844-848
Article info
Publication history
Published online: January 04, 2019
Accepted:
October 28,
2018
Received:
July 30,
2018
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
