ORIGINAL RESEARCH article
Front. Surg.
Sec. Genitourinary Surgery and Interventions
This article is part of the Research TopicInnovative Molecular and Therapeutic Approaches in Conservative Management of Urothelial CarcinomaView all articles
Defining the Learning Curve for Thulium Laser En Bloc Resection of Bladder Tumors: A Single-Surgeon Retrospective Cohort Study
Provisionally accepted
- Yinzhou No.2 Hospital, Ningbo, China
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Objective: 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). Methods: 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. Results: Among 79 successfully completed TL-ERBTs, the mean operation time was 31.6±10.3 minutes. 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 minutes in the Learning phase to 27.8±8.1 minutes 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. Conclusion: 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.
Keywords: Bladder cancer, en bloc resection, Learning Curve, Retrospective, Thulium laser
Received: 16 Jan 2026; Accepted: 04 Feb 2026.
Copyright: © 2026 Qing, Wu and Gao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wenbo Gao
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