Defining the learning curve for thulium Laser en bloc resection of bladder tumors: a single-surgeon retrospective cohort study

TL;DR

This study identifies a learning curve of 32 procedures for a surgeon to become proficient in a new laser-based bladder tumor removal technique.

Contribution

Quantifies the learning curve for TL-ERBT using objective metrics and statistical analysis in an experienced surgeon's practice.

Findings

Proficiency in TL-ERBT was achieved after 32 procedures with significantly reduced operation time.

Conversion to conventional TURBT decreased from 12.5% to 2.1% after reaching proficiency.

Detrusor muscle presence and complication rates remained consistent between learning and proficiency phases.

Abstract

To quantitatively analyze the learning curve for thulium laser en bloc resection of bladder tumor (TL-ERBT) performed by a surgeon experienced in conventional transurethral resection of bladder tumor (TURBT).

In this single-surgeon, retrospective cohort study, the initial 86 consecutive TL-ERBT cases were reviewed. Operation time was used as the primary outcome. Learning curve analysis was performed using moving average and cumulative sum (CUSUM) methods.

Among 79 successfully completed TL-ERBTs, the mean operation time was 31.6 ± 10.3 min. CUSUM analysis identified a turning point at case 32, separating the Learning phase (cases 1–32) from the Proficiency phase (cases 33–86). Operation time significantly decreased from 37.8 ± 9.2 min in the Learning phase to 27.8 ± 8.1 min in the Proficiency phase (P < 0.001). The conversion rate to conventional TURBT declined from 12.5% to 2.1% (P = 0.038). Detrusor muscle presence in specimens (87.3% overall) and major complication rates were comparable between phases.

For a surgeon experienced in conventional TURBT, preliminary evidence from this study suggests that proficiency in TL-ERBT, defined primarily by operative efficiency, may be achievable after approximately 32 procedures, with significant improvements in operative efficiency and technical success; while patient safety was not compromised. These findings provide a practical quantitative benchmark for surgical training and clinical implementation.

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