|
|
|
경요도 전립선 절제술(Transurethral Resection of Prostate)의 경험이 HoLEP의 학습곡석은 극복하는데 미치는 영향 |
| 가톨릭대학교 의정부성모병원 |
| 최우석, 박지운, 배상락, 박봉희, 이용석, 강성학, 한창희 |
Introduction : The purpose of this study was to evaluate the effect of the amount of experience and the experience of the conventional TUR-P on overcoming the learning curve of HoLEP.
Materials and Methods : From 2012 to 2017, HoLEP was performed in patients with prostate hyperplasia in a single institution. Three surgeons who performed TUR-P in more than 300 cases(highly experienced, HE), 100-200 cases(moderate experienced, ME), and less than 10 TUR-P cases(beginner) were analyzed electronical medical records. All of the surgeons experienced HoLEP for the first time and confirmed the timing of overcoming the learning curve. They also evaluated the operation time, enucleation time, morcellation time, transfusion status, objective indicators such as uroflowmetry and residual urine scan, the preoperative and postoperative results were compared through subjective indices.
Results : Total 302 patients were included in this analysis. 117 patients were underwent HoLEP by HE, 107 patients by ME, 78 patients by beginner. All 3 surgeons was winning learning curve after 30 cases. Compared to HE surgeon, beginner had more frequent transfusion rate(0.22 PRC pack vs. 0.43 PRC Pack), more large volume of pre- and postoperative residual urine(98.89 vs. 159.60cc, 46.54 vs. 58.83cc), Preoperative voiding symptoms and storage symptom scores were high (IPSS voiding 2.25 vs. 7.02, storage 1.75 vs. 5.14) There was no significant difference after the operation(voiding 2.72 vs. 3.41, storage 3.35 vs. 4.63) The efficacy of energy, enucleation, and morcellation were higher than ME.(0.41vs.1.26, 0.50 vs.1.23, 3.29 vs. 4.35) Compared with HE, the morcellation time was relatively long(12.01 vs. 17.57min), Energy efficacy and enucleation were also higher than ME, but the difference was not more severe than HE. (0.82 vs 1.26 vs. 0.80 vs 1.23)
Conclusion : The experience of TUR-P did not have a great effect on learning HoLEP. The less knowledge about the existing prostate surgery was rather more cautious, and sometimes it helped the operation to proceed efficiently.
|
|
keywords : Experience, HoLEP, TUR-P |
|
