Greenlight laser: a laser for every prostate and every urologist
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LETTER TO THE EDITOR
Greenlight laser: a laser for every prostate and every urologist Davide Campobasso1 · Giovanni Ferrari2 · Antonio Frattini1 Received: 7 October 2020 / Accepted: 13 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, In the study by Panthier et al. [1], we have an additional demonstration of the Greenlight laser versatility. The authors report on their experience with the 180 W XPS and the 120 W HPS in en bloc Greenlight laser enucleation of prostate (GreenLEP) in 100 consecutive patients, performed by a senior surgeon who had no prior experience in enucleation. The results highlight the low rate of complications and the significant IPSS improvement in all groups (1–30th, 31–60th and 61–100th), with a learning curve of around 30 procedures without any difference in complication rates between the first and the latest cases. These data are in line with the increasing evidence about the safety, effectiveness and versatility of Greenlight in all prostate sizes and for all type of patients and surgeons [2–5]. These aspects are not as clear for HoLEP procedures. Peyronnet et al. [6] reported a learning curve for HoLEP and GreenLEP ranging from 22 to 40 cases and 14 to 30 cases, respectively. However, the study was not designed to asses learning curves, and it reported a retrospective series of two surgeons who worked in different types of hospital (academic versus private). A recent systematic review [7] tried to define a learning curve for HoLEP. The authors concluded that a learning curve of 50 cases should be enough, and in the presence of a structured mentorship program and simulation training, it might even decrease to 25 cases. Of note, in the article by Houssin et al. [8], the authors suggest that operations performed by surgeons with more than 40-cases experience were significantly This comment refers to the article available online at https://doi. org/10.1007/s00345-019-02941-1. * Davide Campobasso [email protected] 1
Department of Urology, Ospedale Civile Di Guastalla and Ospedale Ercole Franchini Di Montecchio Emilia, Azienda USL-IRCCS Di Reggio Emilia, Via Donatori di Sangue 1, 42016 Guastalla, RE, Italy
Department of Urology, Hesperia Hospital, Modena, Italy
2
associated with reduced post-operative urinary incontinence (3.3% versus 6.6% and 6.5% in the comparison groups 70 cases’ experience, even though currently a cut-off of 70 procedures is the more referenced learning curve according to the literature [6]. Data reported by Panthier are in line with the current literature suggesting that unexperienced surgeons need at least 30 procedures to obtain improvements without compromising safety [3]. Their overall complication rate of 31% (with the 86.7% of Clavien I) is in line with other studies on GreenLEP [5, 6]. Interestingly, in the paper by Peyronnet et al. [6] postoperative complication rate was higher in the HoLEP group (40 vs. 16.7%; p = 0.04) during the first 30 procedures. Advantages of laser technology in the treatment of
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