Fiber laser enucleation of the prostate (ThuFLEP): learning curve and early surgical experience in a training program

Objective: to describe the initial experience and evaluate the learning curve of Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) in a training program. Methods: an ambispective study included consecutive patients with benign prostatic enlargement who underwent ThuFLEP between March 2024 and January 2025. Collected variables included demographics, operative times, enucleation and morcellation efficiency, perioperative complications, and functional outcomes at 3 months. Learning progression was assessed using linear regression of enucleation efficiency and operative time across consecutive cases, and by stratifying patients into quartiles according to case order. Results: thirty‑eight patients were included. Mean prostate volume was 74.5 ± 19.6 g, and mean operative time was 83.6 ± 40.3 minutes. Mean enucleation efficiency was 0.75 ± 0.30 g/min. Total operative time decreased by approximately 3 minutes per case (p < 0.01). Most complications were low grade (Clavien-Dindo grade I–II). Significant improvement at 3 months was observed in PSA, IPSS, QoL, and PVR (all p < 0.0001). Operative proficiency reached around case 10-20. Limitations of this study: small sample size, ambispective design, and lack of a comparative group. Originality: this is the first Mexican study describing early experience and the learning curve of ThuFLEP in a training program. Conclusions: ThuFLEP shows a reproducible learning curve in a supervised training environment. Its safety profile, hemostatic properties, and predictable tissue interaction support its use as a technique for surgical education.