From Novice to Expertise: The Evolution of Anatomical Endoscopic Enucleation of the Prostate

Benign prostatic hyperplasia (BPH) surgical treatment has seen significant advancements with the evolution of endoscopic techniques. Among these, Anatomical Endoscopic Enucleation of the Prostate (AEEP) has emerged as a highly effective, minimally invasive alternative to traditional methods like Transurethral Resection of the Prostate (TURP) and open prostatectomy. EEP, performed using various energy sources such as bipolar electrical energy (BipolEP), Holmium Laser (HoLEP), Thulium (ThuLEP), and Green Light Laser (GreenLEP), has been shown to yield excellent outcomes by maintaining the principles of anatomical enucleation. However, mastering AEEP involves acquiring complex skills that require more than just technical knowledge, including selecting the right patient and prostate size, especially during the initial learning curve and understanding prostate surgical anatomy.This Research Topic aims to explore the structured learning process, skill acquisition, and proficiency development in AEEP, offering a comprehensive overview of surgeons’ progress from novices to experts of this challenging procedure. Understanding the nuances of transitioning to a precise enucleation procedure from a non-anatomical approach like TURP requires developing training models, mentorship opportunities, simulation-based learning, and accumulating operative experience.We invite researchers and clinicians to submit their manuscripts to this Research Topic, fostering a collaborative discourse on optimizing surgical education and improving patient outcomes in the evolving landscape of prostate enucleation. We invite original research, systematic reviews, technical how-I-do-it letters, and expert opinions that would contribute to understanding the evolution of surgical skills in AEEP. We welcome articles addressing, but not limited to, the following themes:• Different electrodes and electrosurgical units and their impact on outcomes: how different electrodes (Hermann/Storz loop, Wolf loop, rollerball loop, Colings knife loop, standard loop) and electrosurgical units (monopolar, bipolar) would vary in energy delivery, precision, and tissue effects, impacting surgical outcomes.* Differences between LASER sources and their impact of the surgical technique of AEEP, how different LASERS offer different energy delivery and how this might effect outcomes• Learning curves and performance metrics of AEEP: studies analyzing the number of cases required to attain proficiency, assessment tools for measuring surgical competence, and predictive factors for achieving expertise.• Integration of simulation and technological aids in surgical training: the role of virtual reality, dry-lab and wet-lab simulations, and artificial intelligence in accelerating acquisition of surgical skills.• Strategies for managing intraoperative challenges and difficult cases: common difficulties encountered during the learning curve, troubleshooting complications, and strategies to risk stratify cases in order to achieve a stepwise approach to more challenging cases.• Evaluating complications and effectiveness of training modalities: evaluations of mentored versus non mentored fellowships and the impact of simulation-based training on surgical proficiency, complication rates, and overall skill development.• Factors affecting postoperative stress incontinence: factors affecting postoperative stress incontinence rate based on patient , surgeons and equipment’s.• The impact of previous Minimally Invasive Surgical Techniques on AEEP: what is the impact of the favored Minimally invasive Surgical Techniques (MISTs) that offer fractional de-obstruction when later on comes the need for maximal de-obstruction vie AEEP• Global Perspectives on AEEP Training: cross-institutional comparisons of training models, resource availability, and ways to increase adoption of AEEP in different healthcare settings.By addressing the evolution of surgical skills in AEEP, this Research Topic seeks to outline a roadmap for urologists aiming to gain expertise in this domain. We invite researchers and clinicians to submit their manuscripts to this Research Topic, fostering a collaborative discourse on optimizing surgical education and improving patient outcomes in the evolving landscape of prostate enucleation.We encourage submissions from both early-career and experienced surgeons, as well as institutions pioneering training programs in AEEP. Contributions should offer novel perspectives, evidence-based strategies, and innovative approaches that contribute to the educational framework for mastering AEEP.Dr. Ioannis Kartalas Goumas reports having received grants from Cook Medical, Boston Scientific, Richard Wolf, DIMED, and Innovex Medical. Dr. Petros Sountoulides reports serving as a proctor for Olympus Greece. The other Topic Editors declare no conflicts of interest. Topic editors: PETROS SOUNTOULIDES, Mohamed Kamal Mahmoud Omar Source: https://www.frontiersin.org/research-topics/79728/from-novice-to-expertise-the-evolution-of-anatomical-endoscopic-enucleation-of-the-prostate