Hybrid coverage: Virtual ESU course at Albanian-Kosovan congress
In light of the COVID-19 situation, a hybrid event was organised: the virtual course of the European School of Urology (ESU) took place in conjunction with the national congress of the Albanian Association of Urologic Surgeons and Kosovo Urologists Association.
Approximately 30 urologists were onsite and 80 urologists, doctors and nurses from Albania and Kosovo attended online.
The ESU course themed “Upper tract laparoscopic surgery” was organised with the support of the associations’ respected members, Dr. Oltion Alibali, Dr. Xhevdet Cuni and Dr. Gezim Galiqi. Dr. Jose Maria Gaya Sopena spearheaded the course and with fellow ESU course faculty member, Assoc. Prof. Roman Sosnowski, who both offered expert insights in five highly-informative lectures.
The ESU course commenced with Dr. Gaya Sopena’s presentation on what unique possibilities for urological education the ESU offers. His following presentation "Trans- and retroperitoneal access: Technique and management of complications", Dr. Gaya Sopena shared a new way to place trocars for lap retroperitoneal approach.
New trocar disposition for the retroperitoneal approach (left kidney)
“The new trocar disposition also entails changes in the distribution of the operating room and surgeons positioning which involve better ergonomic movements for the surgeon and the assistant with less clutching, surgical time, and a number of complications,” stated Dr. Gaya Sopena.
He also presented the lectures on the techniques and management of complications with regard to trans- and retroperitoneal access, as well as, laparoscopic pyeloplasty and adrenalectomy.
Prof. Sosnowski shared his expertise during his presentations “Laparoscopic nephrectomy and nephroureterectomy: Technique and management of complications” and “EAU Guidelines recommendations: What are the indications for laparoscopy?”.
In the latter presentation, Prof. Sosnowski stated that according to the EAU Guidelines, surgical management in patients with kidney tumours should be recommended in every possible case, because it is possible to obtain an effective treatment. With regard to small kidney tumours (<T1), partial nephrectomy (PN) is recommended whenever technically feasible.
He added that the ESMO Guidelines for the management of local disease of PN is recommended as the preferred option in organ-confined tumours measuring up to 7 cm (elective indication). PN can be carried out via open, laparoscopic or robot-assisted laparoscopic approaches. Laparoscopic RN is recommended if PN is not technically feasible.
In patients with compromised renal function, solitary kidney or bilateral tumours, PN is also the standard of care, with no tumour size limitation (imperative indication). In terms of T2 tumours (> 7 cm) laparoscopic radical nephrectomy (RN) is the preferred option.
Prof. Sosnowski stated, “Likewise, the NCCN Guidelines constitute RN should not be employed when nephron-sparing surgery can be achieved. When compared with RN, PN can achieve preserved renal function, decreased overall mortality, and reduced frequency of cardiovascular events. Studies show that the oncologic outcome for laparoscopic versus open nephron-sparing surgery appears to be similar.”
He added that according to the EAU Guidelines, tumour resection is potentially curative only if all tumour deposits are excised. This includes patients with the primary tumour in place and single- or oligometastatic resectable disease. For most patients with metastatic disease, cytoreductive nephrectomy (CN) is palliative and systemic treatments are necessary. The recommended surgical technique was not clearly specified.
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