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Paciotti M, Diana P, Gallioli A, De Groote R, Farinha R, Ficarra V, Gaston R, Gontero P, Hurle R, Martínez-Piñeiro L, Minervini A, Pansadoro V, Van Cleynenbreugel B, Wiklund P, Casale P, Lughezzani G, Uleri A, Mottrie A, Palou J, Gallagher AG, Breda A, Buffi N. International consensus panel for transurethral resection of bladder tumours metrics: assessment of face and content validity. BJU Int 2024. [PMID: 38830818 DOI: 10.1111/bju.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
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.
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Affiliation(s)
- Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Pietro Diana
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Rui Farinha
- Urology Department, Lusíadas Hospital, Lisbon, Portugal
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of Urology, University of Messina, Messina, Italy
| | - Richard Gaston
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Paolo Gontero
- Department of Urology, University of Turin, Turin, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Luis Martínez-Piñeiro
- Department of Urology, La Paz University Hospital and La Paz Hospital Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Andrea Minervini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Vito Pansadoro
- Fondazione Vincenzo Pansadoro, Centro di Urologia Laparoscopica e Oncologia Medica, Rome, Italy
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Uleri
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
- Orsi Academy, Melle, Belgium
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Anthony G Gallagher
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
- Orsi Academy, Melle, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Basile G, Gallioli A, Diana P, Gallagher A, Larcher A, Graefen M, Harke N, Traxer O, Tilki D, Van Der Poel H, Emiliani E, Angerri O, Wagner C, Montorsi F, Wiklund P, Somani B, Buffi N, Mottrie A, Liatsikos E, Breda A. Current Standards for Training in Robot-assisted Surgery and Endourology: A Systematic Review. Eur Urol 2024:S0302-2838(24)02304-2. [PMID: 38644144 DOI: 10.1016/j.eururo.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Different training programs have been developed to improve trainee outcomes in urology. However, evidence on the optimal training methodology is sparse. Our aim was to provide a comprehensive description of the training programs available for urological robotic surgery and endourology, assess their validity, and highlight the fundamental elements of future training pathways. METHODS We systematically reviewed the literature using PubMed/Medline, Embase, and Web of Science databases. The validity of each training model was assessed. The methodological quality of studies on metrics and curricula was graded using the MERSQI scale. The level of evidence (LoE) and level of recommendation for surgical curricula were awarded using the educational Oxford Centre for Evidence-Based Medicine classification. KEY FINDINGS AND LIMITATIONS A total of 75 studies were identified. Many simulators have been developed to aid trainees in mastering skills required for both robotic and endourology procedures, but only four demonstrated predictive validity. For assessment of trainee proficiency, we identified 18 in robotics training and six in endourology training; however, the majority are Likert-type scales. Although proficiency-based progression (PBP) curricula demonstrated superior outcomes to traditional training in preclinical settings, only four of six (67%) in robotics and three of nine (33%) in endourology are PBP-based. Among these, the Fundamentals of Robotic Surgery and the SIMULATE curricula have the highest LoE (level 1b). The lack of a quantitative synthesis is the main limitation of our study. CONCLUSIONS AND CLINICAL IMPLICATIONS Training curricula that integrate simulators and PBP methodology have been introduced to standardize trainee outcomes in robotics and endourology. However, evidence regarding their educational impact remains restricted to preclinical studies. Efforts should be made to expand these training programs to different surgical procedures and assess their clinical impact. PATIENT SUMMARY Simulation-based training and programs in which progression is based on proficiency represent the new standard of quality for achieving surgical proficiency in urology. Studies have demonstrated the educational impact of these approaches. However, there are still no standardized training pathways for several urology procedures.
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Affiliation(s)
- Giuseppe Basile
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Anthony Gallagher
- Faculty of Medicine, KU Leuven, Leuven, Belgium; Faculty of Health and Life Sciences, Ulster University, Coleraine, UK; ORSI Academy, Melle, Belgium
| | | | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Harke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Olivier Traxer
- Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Henk Van Der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Oriol Angerri
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Christian Wagner
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | | | - Peter Wiklund
- Icahn School of Medicine, Mount Sinai Health System New York City, NY, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Nicolò Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alex Mottrie
- ORSI Academy, Melle, Belgium; Department of Urology, OLV Hospital, Aalst, Belgium
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain
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Ebm C, Paciotti M, Diana P, Lughezzani G, Casale P, Buffi N. A cost analysis in implementing simulation-based training into a novel urology curriculum. Minerva Urol Nephrol 2023; 75:791-793. [PMID: 37539671 DOI: 10.23736/s2724-6051.23.05481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Claudia Ebm
- Simulation Center, Humanitas University, Pieve Emanuele, Milan, Italy -
| | - Marco Paciotti
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pietro Diana
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Diana P, Baboudjian M, Saita A, Uleri A, Gallioli A, Casale P, Buffi N, Pradere B, Misrai V, Gondran-Tellier B, Boissier R, Schwartzmann I, Breda A, Del Dago PJ. Same-day discharge for endoscopic enucleation of the prostate: a systematic review and meta-analysis. World J Urol 2023; 41:2099-2106. [PMID: 37395755 DOI: 10.1007/s00345-023-04471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE To systematically review studies focused on the feasibility and outcomes of outpatient endoscopic enucleation of the prostate for benign prostatic obstruction. METHODS A literature search was conducted through December 2022 using PubMed/Medline, Web of Science, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Risk of bias assessment was performed according to the Newcastle-Ottawa Scale for case control studies. RESULTS Of 773 studies, ten were included in the systematic review (n = 1942 patients) and four in the meta-analysis (n = 1228 patients). The pooled incidence of successful same-day discharge was 84% (95% CI 0.72-0.91). Unplanned readmission was recorded in 3% (95% CI 0.02-0.06) of ambulatory cases. In the reported criteria-selected patients submitted to SDD surgery, the forest plot suggested a lower rate of postoperative readmission (OR 0.56, 95% CI 0.34-0.91, p = 0.02) and complications (OR 0.69, 95% CI 0.48-1, p < 0.05) rates compared to standard protocols. CONCLUSION We provide the first systematic review and meta-analysis on SDD for endoscopic prostate enucleation. Despite the lack of randomized controlled trials, we confirm the feasibility and safety of the protocol with no increase in complications or readmission rate in well-selected patients.
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Affiliation(s)
- Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy.
- Department of Urology, Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Spain.
- GUA Gabinete de Urología y Andrología, Las Palmas de Gran Canaria, Spain.
| | - Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Alberto Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Nicolomaria Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hospital, 31130, Quint Fonsegrives, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Bastien Gondran-Tellier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Ivan Schwartzmann
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Pablo Juarez Del Dago
- Department of Urology, Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Spain
- GUA Gabinete de Urología y Andrología, Las Palmas de Gran Canaria, Spain
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