HoLEP learning curve and strategies for successful adoption, with Daniel S. Kellner, MD

In this video, Daniel S. Kellner, MD, discusses patient selection for holmium laser enucleation of the prostate (HoLEP) and strategies for surgeons looking to adopt the technically challenging procedure. Kellner is an associate professor of urology at Yale School of Medicine in New Haven, Connecticut.

To begin the discussion, Kellner notes that HoLEP is considered a size-independent procedure and can be used across a broad range of prostate sizes. For surgeons early in their experience with the procedure, however, he recommends starting with medium-sized prostates, approximately 60 to 100 cm³, where an enucleation plane may be easier to identify. He emphasized that very large prostates can be challenging for inexperienced surgeons, while smaller prostates may also present difficulties in identifying the appropriate plane.

Kellner also acknowledges that HoLEP has a steep and highly variable learning curve, making institutional support and a dedicated surgical team important for successful adoption. While literature suggests that surgeons may require 20 to 50 cases to overcome the initial learning curve, he says proficiency and efficiency may actually take longer.

“I think it could actually take several hundred cases before you get very good and efficient with HoLEP,” Kellner said.

For surgeons interested in adopting HoLEP, Kellner recommends developing a structured plan that includes access to appropriate equipment and support from hospital staff and operating-room teams. He also points to the growing number of educational resources available, including online surgical videos, industry-supported masterclasses, digital simulators and hydrogel models, as well as courses offered through the American Urological Association. These resources, he says, provide surgeons with more opportunities to develop their skills before and during clinical adoption of the procedure.