Novel surgical techniques in urological surgery were demonstrated during the live surgeries in the Meeting of the EAU Section of Uro-Technology (ESUT). Prof. Dr. Alex Mottrie (BE) performed a robotic partial nephrectomy using isocyanine green (ICG) injection, and Prof. Palle Osther (DK) removed a renal stone using a shock pulse instrument in a combined PCNL-FURS procedure.
Mottrie, who was assisted by Dr. Andrea Volpe (IT), operated on a 48-year-old male with a cystic tumour in the lower pole of the right kidney. While Mottrie performed the surgery with a robotic surgical system, Volpe was at the bedside. Mottrie emphasised that it is important to have an additional experienced surgeon in the room who knows exactly what needs to happen and who can assist in case of complications.
After the kidney had been exposed and clamped, the ICG was injected and the screen switched to black and white. The fatty tissue and liver turned green while the clamped kidney did not change colour. Then the lesion was removed and the kidney was closed.
Osther, assisted by Prof. Dr. Olivier Traxer (FR), showed how to remove a 2 cm renal stone in a 64-year-old woman. They used a combined technique of supine percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (FURS), which gave them vision from two sides with only one puncture. The shock pulse PCNL instrument was used to pulverise the stone and, occasionally, larger fragments needed to be removed with a grasper.
Osther stressed that it is important not to touch the flexible scope with the pulse instrument because it will immediately damage it. The aim of the surgery is for the patient to be stone free. “Although definitions sometimes vary,” Osther said, “for me, stone free means absolutely stone free.”
The advantage of combined management is that the FURS can potentially be used to take out remaining stone fragments with the basket. In this case that was not necessary and the combined view made it easier to check for any remaining fragments.