Validation of a novel assessment tool identifying proficiency in Transurethral Bladder Tumour Resection: The OSATURBS assessment tool

Recent Advances and Emerging Innovations in Transurethral Resection of Bladder Tumor (TURBT) for Non-Muscle Invasive Bladder Cancer: A Comprehensive Review of Current Literature

Bladder cancer management, particularly non-muscle-invasive bladder cancer (NMIBC), has evolved significantly due to advancements in imaging techniques and surgical methodologies. Enhanced tumor visualization methods, including Photodynamic Diagnosis (PDD) and Narrow-Band Imaging (NBI), offer improved detection rates for both papillary tumors and carcinoma in situ (CIS), compared to traditional white-light cystoscopy (WLC). Recent studies suggest that these technologies enhance diagnostic accuracy, reduce recurrence rates, and improve oncological outcomes. Additionally, transurethral resection of bladder tumors (TURBT), performed with advanced imaging, has demonstrated better resection quality, particularly in terms of detrusor muscle presence. Despite these innovations, challenges remain in the long-term impact on recurrence-free and progression-free survival. Artificial intelligence (AI) integration into cystoscopic imaging further promises enhanced diagnostic precision and cost-effective bladder cancer management. As personalized treatment paradigms emerge, predictive biomarkers, including genomic and pathological markers, may help stratify patients for aggressive treatment, sparing those at lower risk from unnecessary interventions. Future research should focus on validating these AI models and combining them with enhanced imaging modalities to refine treatment protocols further. These advancements collectively represent a significant leap toward precision medicine in bladder cancer care.

For Your Eyes Only? The Use of Surgical Videos in Urological Residency Training: A European-wide Survey

Background and objective

Video-based learning may be beneficial in surgical education, both in the preparation for surgery and to evaluate surgical performance. The use of a video is not yet anchored in European urology residency programs, and it is unclear how frequently residents use videos. The purpose of this study is to investigate whether and how urology residents utilize videos to prepare for surgical procedures and evaluate their surgical performance.

Methods

We conducted a European-wide, survey-based, needs assessment among urology residents. The survey was distributed electronically among the participants in the European Urology Residents Education Program 2022 and all the members of the European Society of Residents in Urology.

Key findings and limitations

Seventy-two surveys were completed by the residents of 12 nationalities. Of the residents, 98.6% used videos in preparation, mainly for open, laparoscopic, and robotic procedures. YouTube was by far the most used source. Of the residents, 86% believed that a postsurgical video review would be helpful. In total, 39% of the residents actually had this possibility. Of them, 30% had the opportunity to do this together with a supervisor.

Conclusions and clinical implications

This study demonstrated that European urology residents often use videos to prepare surgical procedures. Considering that the majority of the respondents use YouTube as the main source of videos, this seems not to be formalized within their training. Although most residents would value a postsurgical video review, preferably together with a supervisor, the latter is not available to the majority. We recommend the use of professional, and not public, video channels and easier access to postsurgical video review.

Patient summary

Video-based learning may have an important role in surgical education. Videos often are a source of education for European urology residents to prepare for surgical procedures. Although most residents would appreciate a postsurgical video review or video-based coaching, this is not available to the majority of them.

Current Standards for Training in Robot-assisted Surgery and Endourology: A Systematic Review

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.

Laypersons versus experienced surgeons in assessing simulated robot-assisted radical prostatectomy

BACKGROUND

Feedback is important for surgical trainees but it can be biased and time-consuming. We examined crowd-sourced assessment as an alternative to experienced surgeons' assessment of robot-assisted radical prostatectomy (RARP).

METHODS

We used video recordings (n = 45) of three RARP modules on the RobotiX, Simbionix simulator from a previous study in a blinded comparative assessment study. A group of crowd workers (CWs) and two experienced RARP surgeons (ESs) evaluated all videos with the modified Global Evaluative Assessment of Robotic Surgery (mGEARS).

RESULTS

One hundred forty-nine CWs performed 1490 video ratings. Internal consistency reliability was high (0.94). Inter-rater reliability and test-retest reliability were low for CWs (0.29 and 0.39) and moderate for ESs (0.61 and 0.68). In an Analysis of Variance (ANOVA) test, CWs could not discriminate between the skill level of the surgeons (p = 0.03-0.89), whereas ES could (p = 0.034).

CONCLUSION

We found very low agreement between the assessments of CWs and ESs when they assessed robot-assisted radical prostatectomies. As opposed to ESs, CWs could not discriminate between surgical experience using the mGEARS ratings or when asked if they wanted the surgeons to perform their robotic surgery.

Surgical experience is predictive for bladder tumour resection quality

OBJECTIVES

To assess the resection quality of transurethral bladder tumour resection (TURBT) and the association to surgeon experience depending on the presence of detrusor muscle.

METHODS

A retrospective study on 640 TURBT procedures performed at Zealand University Hospital, Denmark, from 1 January 2015 - 31 December 2016. Data included patient characteristics, procedure type, surgeon category, supervisor presence, surgical report data, pathological data, complications data and recurrence data. Analysis was performed using simple and multiple logistic regression on the association between surgeon experience and the presence of detrusor muscle in resected tissue from TURBT.

RESULTS

Supervised junior residents had significant lower detrusor muscle presence (73%) compared with consultants (83%) (OR = 0.4, 95% CI = 0.21-0.83). Limitations were the retrospective design and the diversity of included TURBT.

CONCLUSIONS

It was found that surgical experience predicts detrusor muscle presence and supervised junior residents performing TURBT on patients resulted in less detrusor muscle than consultants.

National Implementation of Simulator Training Improves Transurethral Resection of Bladder Tumours in Patients

Background

Objective

Design, setting, and participants

Outcome measurements and statistical analyses

Results and limitations

Conclusions

Patient summary