Journal of endourology
October 19, 2026 · via Europe PMC
NASA-TLX Reveals Cognitive Workload Across the HoLEP Learning Curve from Our First 100 Cases.
Rege R, Sandoval V, Ceraolo C, Jain R, Quarrier S, Sharma N.
AI summary — for doctors, generated from the abstract only
In a community surgeon's first 103 HoLEP cases, operative efficiency and self-rated workload improved steadily without a measurable difference in complications or continence.
What was studied
Single-surgeon prospective cohort of 103 HoLEP patients at an ambulatory surgery center, divided into three sequential groups and compared on operative metrics, NASA-TLX workload, 90-day complications and continence.
Key findings
- Operative time, enucleation time, laser energy, fluid use, enucleation speed and NASA-TLX all improved across groups.
- No significant differences emerged in 90-day complications or continence at any follow-up.
- Lower NASA-TLX score independently predicted a later learning-curve group (OR 0.83, 95% CI 0.70-0.98).
Clinical relevance
Perceived workload may offer a practical marker of proficiency for surgeons adopting HoLEP outside academic centers.
Who should care
Limitations
Single surgeon, single center, and no external validation; outcome comparisons may be underpowered for rare complications.
Consider tracking NASA-TLX alongside operative metrics when training or assessing HoLEP proficiency.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Introduction
Holmium laser enucleation of the prostate (HoLEP) has a steep learning curve, which limits widespread adoption. Objective metrics to define surgical proficiency, efficiency, and perceived workload remain underexplored outside academic institutions. This study aimed to characterize the learning curve of HoLEP from one single surgeon at an ambulatory surgical center.
Methods
A total of 103 patients underwent HoLEP for BPH between March 2024 and August 2025. Surgical cases were stratified into 3 sequential groups of 34, 34, and 35 cases, respectively, based on operative chronology. Operative characteristics were compared across groups: enucleation time, laser energy, fluid use, and enucleation speed (enucleation time/specimen weight). Perceived workload was assessed using the NASA Task Load Index (NASA-TLX) to evaluate perceived workload across several "performance" domains (mental demand, physical demand, temporal demand, performance, effort, and frustration). Comparisons of outcome metrics were made for 90-day postoperative complications. Urinary continence outcomes were evaluated at 1 week, 1 month, and 3 months postoperatively. Univariable and multivariable multinomial logistic regression analyses were performed to examine associations between surgical characteristics and group classification.
Results
Progressive improvement was observed in operative time, enucleation time, laser energy, total fluid, enucleation speed, and NASA TLX, as seen in Table 1. No statistically significant associations were observed between group classification and 90-day postoperative complications or urinary continence outcomes at any follow-up interval. In multivariable multinomial logistic regression analysis, the NASA-TLX score (OR 0.83, 95% CI, 0.70-0.98, p = 0.02) remained an independent predictor of higher learning curve classification. (Table 2).[Table: see text][Table: see text]Conclusions:Progressive reductions in operative time, energy use, and perceived workload signify quantifiable improvement over the first 100 cases in a community hospital, The NASA-TLX score remained independently associated with improvement in proficiency, outperforming traditional operative measures in defining the HoLEP learning curve.
DOI
10.1177/08927790261500971
PMID
42897868
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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