Switching lasers: comparing efficacy, efficiency, and safety in learning curves of three surgeons with different experience levels in holmium laser enucleation of the prostate (HoLEP) for pulsed thulium laser enucleation of the prostate (ThuLEP)

<strong>Objective</strong>: To compare learning curves for pulsed thulium laser enucleation of the prostate (ThuLEP) for three surgeons with different levels of surgical experience. <strong>Methods</strong>: We prospectively analyzed the first 100 consecutive cases of ThuLEP surgery for a very experienced (&gt;1000 previous HoLEPs), an experienced (&gt;200 previous HoLEPs) and an unexperienced surgeon (no HoLEPs), undergoing a structured training program, regarding perioperative parameters, functional outcomes, and safety. Patients were randomized 1:1:1. <strong>Results</strong>: While postoperative functional outcomes didn’t differ, we report a faster learning curve for experienced surgeons, with the very experienced surgeon learning twice faster than the experienced counterpart. Experienced surgeons reach a plateau twice earlier in enucleation efficiency (g/min) and enucleation time (min), while utilizing half of laser energy (kJ). <strong>Significance</strong>: Pulsed ThuLEP shows a comparable learning curve to HoLEP for the unexperienced surgeons, when following a structured training program. Switching lasers is safe and feasible for surgeons already experienced in HoLEP.