Switching lasers: assessing the learning curves of surgeons with different levels of surgical experience when switching from HoLEP to pulsed Thulium YAG lasers for ThuLEP

Objectives: This study aims to assess the learning curves associated with pulsed Thulium laser enucleation of the prostate (ThuLEP) among three surgeons with varying levels of experience in Holmium laser enucleation of the prostate (HoLEP) as a treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement, with pulsed ThuLEP being one of the newest systems for the surgical treatment of male LUTS. Methods: We conducted a prospective analysis of the first 100 consecutive ThuLEP procedures performed by three surgeons with varying levels of HoLEP experience: one highly experienced (>1,000 prior HoLEP surgeries), one moderately experienced (>200 prior HoLEP surgeries), and one novice surgeon (with no prior HoLEP surgeries) undergoing a structured training program. The evaluation focused on perioperative characteristics, functional results, and safety outcomes. Results: While postoperative functional outcomes were comparable across all groups, experienced surgeons demonstrated a steeper learning curve. The highly experienced surgeon achieved proficiency approximately twice as quickly as the moderately experienced one. Surgeons with prior HoLEP experience reached a performance plateau in enucleation efficiency (g/min) and enucleation time (min) roughly twice as quickly, while requiring only about half the laser energy (kJ). Training a HoLEP-inexperienced surgeon in ThuLEP proved both feasible and safe when conducted within a structured training program. Conclusions: Pulsed ThuLEP shows a learning curve comparable to HoLEP for inexperienced surgeons when performed following a structured training program. Switching lasers is safe and feasible for surgeons already experienced in HoLEP.