Robotics gain ground, but open surgery will stay

The increasing use of minimally invasive procedures such as robot-assisted surgery will continue but open surgery remains a mainstay for many cases, according to Prof. Claude-Clement Abbou during a discussion on minimally invasive therapies at the 7th South Eastern European Meeting (SEEM) which opened this morning in Skopje."Laparoscopic surgery are now replacing when possible open surgery. But open surgery is here to stay for specific indications," said Abbou in his lecture. Abbou also formally opened the 7th SEEM which gathered in Skopje around 250 participants for a two-day discussion and presentation of urological issues covering uro-oncology, paediatric/female urology and stones, among many other topics.

"The less invasive the surgery the greater the physiological benefit, and the less the medical complications," said Abbou.

He, however, noted that there are still lingering doubts and serious challenges to the efficacy and role of the robotic assisted-approach in radical prostatectomy. Among these are the skill levels of surgeon, the pertinent question regarding the importance of robot-assisted techniques, cost issues and patient perception, and not the least, the lack of evidence-based medicine (EBM).

But although the obstacles to a wider adoption of robotic techniques, Abbou said the march of technology will continue. He anticipated that from robotic-assistance available today, it will eventually evolved to "active robotic systems."

Among the conditions that will lead to active robotic systems are the "huge experience" gained in the industry, the increasing standardisation of surgical techniques, the refinement of image through CT and magnetic resonance imaging (MRI), more accurate anatomic recognition, the role of augmented reality, and the availability of software for guidance (I.e, GPS-like software systems).

He also discussed techniques in improving nerve-sparing radical prostatectomy such as the athernal dissection near the neurovascular bundle (NVB) which may hasten the recovery of erectile dysfunction, and the potential protective benefits of hypothermic techniques, among others.

In laparoscopic RP, Abbou also noted that the routes of the dissection can be tailored for each patient depending on the stage of the disease. On the issue of suspending the bladder neck and the posterior wall, Abbou said the issue remains controversial but the approach is logical.