Day 2: Technology and Surgical Skill

09 July 2016

Before the 3D live surgery started, the second day of ESUT16 opened with a discussion on the merits of different technical approaches for urologists. Focussing on technique as much as technology, the state-of-the-art lectures and discussions gave a good sense of what ESUT wanted to cover in its 5th Meeting. Over 600 delegates convened in Athens on July 7-10 to be informed on technology, watch live surgery and discuss with their peers.

Prof. Francesco Montorsi, former Editor-in-Chief of European Urology and now Adjunct Secretary General of the EAU gave the first state-of-the-art lecture of the busy second day of ESUT16. He gave a complete update on the latest literature and evidence on anatomical and technical developments for radical prostatectomy.

What followed was a debate between Profs. Chlosta and Pansadoro, on the merits of laparoscopic and robotic prostatectomy, respectively. Chlosta made his case carefully, pointing to the lack of solid evidence for the advantages our robotic surgery, despite it already being an essential part of the urologist’s armamentarium. “Benefits for patients like recovery, or sexual function are still unclear or statistically insignificant.”

Chlosta emphasised that the experience of the surgeon is key, irrespective of the tools used. “In experienced hands, both laparoscopic and robotic radical prostatectomy yield comparable rates of cancer control, shorter lengths of hospital stay and fewer blood transfusions than open RP. All are technically challenging procedures, with outcomes primarily related to surgeon skill and experience. Robotic surgery is clearly the future, but when you also factor in cost, it’s clear that laparoscopic prostatectomy very much still has its use.”

Prof. Pansadoro came straight to the point, citing figures of the huge adoption of surgical robots since their commercial introduction. For radical prostatectomy, 86% of all procedures were performed robotically in 2015.

Pansadoro: “This success story speaks for itself. The skills of the surgeon count, but we can safely say that we’ve reached the ‘end of controversy’ with regards to the adoption of robotic urology. We are not likely to see a randomized controlled trial of the two techniques, and studies of administrative databases is probably as good as it’s going to get.”

Pansadoro also mentioned the ergonomic benefits for surgeons as the two speakers rebutted each other, also taking questions from the audience. “Being seated, with arm- and headrests and with hand tremors being less of an issue: all of these are advantageous to the surgeon.”

Speaking after the debate, Prof. Chlosta was asked if the debate was illustrative and academic, or if urologists were still evaluating robotic surgery.

“We were not really debating the future of uro-technology, but more establishing the ‘final role’ for older techniques like open surgery or manual laparoscopy for the treatment of prostate cancer.”

“I must emphasise: we are keyhole surgeons, enthusiastic about technology. Our goal is the patient and achieving the best medical result. We cannot be uro-technicians.”