Strategies to improve the learning curve of holmium laser enucleation of the prostate (HoLEP) in Peru

Objective: To describe the cases required to achieve the learning curve, the effective enucleation and morcellation rates, and the strategies to improve the learning curve: Hands-On courses, use of simulators, and surgeries performed with a proctor. Method: A questionnaire was used to assess the number of cases to achieve the learning curve of four urologists and another questionnaire for the Hands On course participants. Results: Learning curve reached with 30 cases, effective enucleation rate was 0.88 g/min (< 80 g) and 1.02 g/min (> 80 g), effective morcellation rate was 4.76 g/min (< 80 g) and 5.30 g/min (> 80 g), 60% of participants showed a satisfaction level of 10 points with the Hands On course, 86% rated live surgeries with a score ≥ 9 points, and 87% perceived improvement in their learning with the course. Conclusions: The learning curve can be shortened with Hands On training courses (use of simulators and viewing live surgeries), and if the procedures are performed with a tutor physician to guide the first procedures.