Enucleation of the prostate: An anatomical perspective

Oh, Seung‐June; Shitara, Tetsuya

doi:10.1111/and.13744

Cited by 16 publications

(15 citation statements)

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“…Different AEEP techniques (eg, three-lobe and enblock) have been reported in the literature [2] , [30] . We focused on the “omega sign” AEEP technique because it represents our standard of care technique, other than for its favorable perioperative and functional outcomes [31] .…”

Section: Discussionmentioning

confidence: 99%

“…It has been more than 20 yr since the adoption of AEEP surgery in urological practice [1] . Despite the popularity of AEEP surgery in the urological community, AEEP has not become widespread due to the lack of a standardized surgical technique as well as a training program, limitations in terms of access to equipment, and a steep learning curve [2] , [3] . The anatomy of the surgical technique in AEEP differs from that in transurethral resection of the prostate (TURP); surgeons may experience difficulties and stress when first using AEEP, and face the morcellation process [2] .…”

Section: Introductionmentioning

confidence: 99%

“…Despite the popularity of AEEP surgery in the urological community, AEEP has not become widespread due to the lack of a standardized surgical technique as well as a training program, limitations in terms of access to equipment, and a steep learning curve [2] , [3] . The anatomy of the surgical technique in AEEP differs from that in transurethral resection of the prostate (TURP); surgeons may experience difficulties and stress when first using AEEP, and face the morcellation process [2] . Anxieties surrounding learning a new technique, in addition to associated perioperative complications in their first AEEP surgeries, can result in many surgeons abandoning AEEP in favor of TURP surgery or simple prostatectomy [4] , [5] .…”

Section: Introductionmentioning

confidence: 99%

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Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study

Tunç

Bozzini

Scoffone³

et al. 2021

European Urology Open Science

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Background Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. Objective To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participants Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysis The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates ( N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitations A total of 26 answers were returned (81%). The experts agreed on the model’s suitability for AEEP training (mean Likert score: 8). According to the responses, “identifying anatomic structures and landmarks” was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model’s ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) Conclusions Based on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summary An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study

Tunç

Bozzini

Scoffone³

et al. 2021

European Urology Open Science

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“…Several changes in the traditional enucleation technique and new surgical techniques, including en bloc or three‐lobe, were reported. These changes have occasionally been described in the time chart of surgical development to increase AEEP’s efficiency and wide adoption (Oh & Shitara, 2020). As a result, AEEP provides strong long‐term objective outcomes with fewer peri‐ and post‐operative complications.…”

Section: Discussionmentioning

confidence: 99%

Is ‘Omega Sign’ anatomical endoscopic enucleation of the prostate technique reproducible?

et al. 2021

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We aimed to evaluate the learning curve of the surgically standardised ‘Omega Sign’ anatomical endoscopic enucleation (AEEP) of the prostate surgery technique for junior surgeons. This study is a retrospective comparison of cases that underwent AEEP by a mentor surgeon and three junior surgeons who have completed their learning curve. A video‐based laser enucleation of the prostate assessment tool (LEAT) composed of 8 steps of the technique was used to assess a senior surgeon and junior surgeons’ surgical compatibility and consistency. The surgeon who defined Omega Sign technique was determined as group 1, and cases by three junior surgeons were identified as group 2. The end points were to assess the reproducibility and repeatability and operative post‐operative outcomes of the technique. 55 patients’ videos were rated by five experienced endourologists. There was no significant difference in LEAT scores between the groups among all steps. The most symmetry was found in the 1st and 3rd steps. Inter‐rater consistency was also high for each step, with no statistically significant difference between the evaluators. The standardised anatomical ‘Omega Sign’ technique is reproducible for the junior surgeons. The operative steps can be performed with high consistency, and the functional and perioperative outcomes are comparable with the senior surgeon.

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“…The Special Issue involves a comprehensive list of chapters and offers a concise overview of AEEP in a systematic approach. Following the introduction from the historical and anatomical perspective (Reddy, Utley, & Gilling, 2020; Oh & Shitara, 2020), different techniques of AEEP by different energy source are illustrated (Ryang, Ly, Tran, Oh, & Cho, 2020; de Figueiredo, Cracco, de Marins, & Scoffone, 2020; Herrmann & Wolters, 2020; Rijo & Misrai, 2020). The surgical outcomes, with emphasis on postoperative continence and sexual functions, and complications of AEEP are summarised in the following chapters (Chen, Chung, Chu, Chen, & Ho, 2020; Lee, Cho, Juan, & Teoh, 2020; Cheng, Li, & Yu, 2020; Wei, Ke, Xu, & Xue, 2020) before a debate on AEEP as the next gold standard treatment for benign prostatic obstruction (Aho, Armitage, & Kastner, 2020; Wroclawski, Teles, & Carneiro, 2020).…”

mentioning

confidence: 99%