En bloc greenlight laser enucleation of prostate (GreenLEP): about the first hundred cases
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ORIGINAL ARTICLE
En bloc greenlight laser enucleation of prostate (GreenLEP): about the first hundred cases Frédéric Panthier1 · Jennifer Pasquier2 · Sébastien Bruel3 · Vidal Azancot3 · Alexandre De La Taille1 · Daniel Gasman3 Received: 12 June 2019 / Accepted: 29 August 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose To report the functional outcomes, perioperative morbidity and surgical learning curve key points using “en bloc” greenlight enucleation of prostate (EB-GreenLEP) for patients with refractory lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods Between December, 2015 and May, 2018, all consecutive patients with refractory LUTS due to BPH in our institution were included and underwent EB-GreenLEP by a single surgeon. Perioperative data, complications and functional outcomes at 1-, 6- and 12-month follow-ups were collected and retrospectively analyzed. Results One hundred patients were included whose median age was 69 years. The median prostate volume (PV) was 84 mL and median enucleated PV was 45.5 mL. Mean irrigation, catheterization and hospitalization times were 1.3, 1.4 and 1.6 days, respectively. Average follow-up was 9.3 months. A single high-grade Clavien-Dindo complication occurred. No urinary retention was reported. Two conversions to conventional resection of the prostate were noted. Three patients had postoperative urinary incontinence at 6 months, only one at 1 year (1%). At 1, 6 and 12 months, there was a significant improvement in IPSS score, QoL and Qmax. Enucleation and energy efficiency ratios were shorter after the 30th procedure. We demonstrated a linear correlation between enucleation time and PV (r = 0.53, p 80 mL) [5]. For the smaller BPH (gland size between 60 and 80 mL), there is no general agreement as to the optimal surgical treatment; urologists must therefore decide which one of the following procedures they will use: TURP, vaporization, EEP and OSP. In the “en bloc” greenlight enucleation
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of the prostate (EB-GreenLEP), the enucleation of all the lobes is done in a single piece followed by a mechanical morcellation. Surgical dexterity and outcomes, being as they are crucial to a patient’s successful recovery, are constant concerns in greenlight, and for this reason different composite tools like the trifecta and the pentafecta have been developed for GreenLEP and HolEP [6, 7]. While they measure integrate different parameters such as operating time, the success rate and absence of complications, they do not, however, include the surgical learning curve, which provides valuable information on how to best evaluate the perioperative outcomes of patients undergoing surgical procedures. At present, the EB-GreenLEP learning curve and the mid-term results remain unknown. This purpose of this study is to report on the functional outcomes, perioperative morbidity and the determinants in the surgical learning curve for EBGreenLEP in a single-center and single-surgeon experiment.
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