The DEpth of Endoscopic Perforation scale to assess intraoperative perforations during transurethral resection of bladder tumor: subgroup analysis of a randomized controlled trial

International consensus panel for transurethral resection of bladder tumours metrics: assessment of face and content validity

OBJECTIVE

To develop performance metrics that objectively define a reference approach to a transurethral resection of bladder tumours (TURBT) procedure, seek consensus on the performance metrics from a group of international experts.

METHODS

The characterisation of a reference approach to a TURBT procedure was performed by identifying phases and explicitly defined procedure events (i.e., steps, errors, and critical errors). An international panel of experienced urologists (i.e., Delphi panel) was then assembled to scrutinise the metrics using a modified Delphi process. Based on the panel's feedback, the proposed metrics could be edited, supplemented, or deleted. A voting process was conducted to establish the consensus level on the metrics. Consensus was defined as the panel majority (i.e., >80%) agreeing that the metric definitions were accurate and acceptable. The number of metric units before and after the Delphi meeting were presented.

RESULTS

A core metrics group (i.e., characterisation group) deconstructed the TURBT procedure. The reference case was identified as an elective TURBT on a male patient, diagnosed after full diagnostic evaluation with three or fewer bladder tumours of ≤3 cm. The characterisation group identified six procedure phases, 60 procedure steps, 43 errors, and 40 critical errors. The metrics were presented to the Delphi panel which included 15 experts from six countries. After the Delphi, six procedure phases, 63 procedure steps, 47 errors, and 41 critical errors were identified. The Delphi panel achieved a 100% consensus.

CONCLUSION

Performance metrics to characterise a reference approach to TURBT were developed and an international panel of experts reached 100% consensus on them. This consensus supports their face and content validity. The metrics can now be used for a proficiency-based progression training curriculum for TURBT.

En bloc resection of bladder tumors (ERBT) revisited 12 years after reintroduction: too good to be further ignored

En bloc resection of bladder tumors (ERBT) orginally described in 1980 and adopted by few centers in the late 1990s has regained attention in the 2010s as a renaissance of a technique with high potential. The advent of new lasers indirectly lead to a better understanding of anatomical dissection from the experience in anatomical dissection in endoscopic enucleation of the prostate. 12 years after the reintroduction of ERBT evidence mounts that it is not only equivalent but better in some regards. However, ERBT still falls short with regard to wide adoption despite the striking technique inherent and reproducible features of accurate staging and specimen quality as requested by pathologist, as well and despite the high intraoperative safety and fast adoption of this technique even in early phase of training. The editorial walks the reader through the timeline of the renaissance speculating why there is a blockage between cognitive understanding and dissonance in surgical practice. The special issues presents the meta-analysis of surgical and oncological data on one hand and the level of understanding and power of this surgical technique in fields offsite oncological results in training achieving results almost right from the start after adoptation. Unlike in earlier years reviewing the literature of ERBT in 2023, ERBT seems not only to be a viable alternative, but something one should turn towards no to underperform with regards to the endpoints achievable by ERBT in a critical disease like bladder cancer.