From Novice to Expertise: The Evolution of Bipolar 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 similar outcomes while maintaining consistent principles of anatomical enucleation. BipolEP stands out for its cost-effectiveness and accessibility, even for surgeons with limited experience in TURP. However, mastering BipolEP involves acquiring complex skills that require more than just technical knowledge, including selecting the right patients, using the correct electrode shape, and understanding prostate surgical anatomy. Despite its steep learning curve, BipolEP provides superior outcomes in efficacy, safety, and long-term success.

This Research Topic aims to explore the structured learning process, skill acquisition, and proficiency development in BipolEP, 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 bipolar enucleation of the prostate. 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 BipolEP. 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.
• Learning curves and performance metrics of BipolEP: 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 BipolEP in different healthcare settings.

By addressing the evolution of surgical skills in BipolEP, 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 bipolar enucleation of the prostate.

We encourage submissions from both early-career and experienced surgeons, as well as institutions pioneering training programs in bipolar AEEP. Contributions should offer novel perspectives, evidence-based strategies, and innovative approaches that contribute to the educational framework for mastering bipolar 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.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
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Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Anatomical Endoscopic Enucleation of the Prostate (AEEP), Bipolar Enucleation of the Prostate (BipolEP), Surgical Training, Minimally Invasive Surgical Techniques (MISTs), Electrosurgical Techniques and Outcomes, Prostatectomy, Patients Outcome

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.