The 11th Meeting of the EAU Robotic Urology Section, held on September 17-19 in Amsterdam showcased many of the latest developments in robotic urology in its live surgery-heavy scientific programme. Dr. Henk van der Poel, local organiser, speaks on optics in robotic surgery and the meeting in general.
Having performed a sentinel lymph node and extended radical prostatectomy the afternoon before, Dr. Van der Poel explains the unusual colours that the audience was treated to during the procedure. “We used both Storz FI near- infrared and Intuitive Firefly to highlight different optical techniques that are available to surgeons. We use tracers that do not show up in natural white light, preserving the normal view for the surgeon. By using special wavelengths of light, we can reveal much more information than is available to the naked eye.”
During the procedure, which involved fluorescent and radiological tracer injection into the prostate to reveal the nodes, the audience followed along, with different filters and views showing different parts of the anatomy. Van der Poel: “There aren’t any standards yet, using different tracers will allow tissue labelling in the future. I would expect that in ten years’ time, everyone will have implemented imaging modalities that provide detailed information on tissue properties e.g. cancer location What we demonstrated yesterday was truly cutting-edge but only the beginning of image guided surgery.”
Speaking more generally on ERUS14 in his position as chair of the local organising committee, Dr. Van der Poel explained some of the choices behind the scientific programme.
“This marks the first year that the ERUS meeting is completely organised by the EAU. We’ve seen around 700 registrations, which is extremely encouraging. In terms of what we have to offer, my personal interest is training.” ERUS14 offered several daily sessions of hands-on training for novice surgeons and those who wanted to familiarise themselves with the basics of robotic surgery. In addition, there was an extensive “YAU-Jr. ERUS” programme for the beginning robotic urologist.
“We’re making strides towards certification for robotic surgery. In the Netherlands, people drove cars for thirty years before the concept of a “driver’s license” based on testing was introduced in the 1920s. Of course we don’t want a repeat of that in robotic surgery. We’re developing a certification process and the results of the second, six-month pilot were presented at ERUS14. We’re also gaining a lot of data and insights from the hands-on training and simulation programmes that we have. Steps during a surgical procedure are now analysed individually, helping pinpoint where improvement of the individual surgeon is needed.”
“Rather than wait for laws to come into practice, we are already gaining insights so that we can advise cut-off points for robotic competence. The EAU helps by supporting this scientific side of the debate: publications, gathering data and strengthening our case in that regard.”
Live surgery and nurses
Instead of being confined to Amsterdam, Dr. Van der Poel was pleased to highlight the national level of cooperation that made the live surgery aspect of the congress possible. While all delegates were gathered in the Beurs van Berlage in the Dutch capital, the actual surgery took place in the Maasstad Hospital in Rotterdam. The distance of 70km between the two locations was a new distance record for live transmission at an ERUS meeting. “This is truly a nationwide effort, involving patients from all across the country being referred to Rotterdam to make this possible. It’s a testament to the efforts of Dr. Sjoerd Klaver and his team that all national and EU-protocols were followed to the letter, as well as the EAU’s own Policy on Live Surgery.”
More and more urological events are following the EAU’s policy, which puts patient concerns first. “The EAU can be commended for facing up to concerns about live surgery. Session chairs are required to interrupt the two-way broadcast if he or she feels the surgeon is distracted. There is also an independent doctor, a patient advocate closely monitoring proceedings to ensure that the patient is getting the best possible care.”
While live surgery is an important draw, Dr. Van der Poel emphasises that presentations based on pre-recorded footage are valuable as well. “It can be an advantage to pause the footage, and to know how the procedure ends. At the next ERUS meeting, we will present the follow-up for the patients operated in Rotterdam, but with pre-recorded cases, we of course already have this information.”
The ERUS Section Meeting was accompanied by a uniquely large scientific programme for nurses, which took place on September 17th. Van der Poel: “Right from the start of ERUS, when it was still an independent society, we had close cooperation with the nurses that were involved in robotic surgery. We have to work together as a team during surgical procedures, so it makes sense to train together as well. There’s new simulators that can train surgeons and nurses simultaneously. We see an exchange of speakers between the two groups, each can offer his or her own insights to the other group, of course. Nurses deal with the patient much more intensively, offering longer-term pre- and postoperative care.”
Full details on the EAUN programme at ERUS 2014 will be published shortly, including an interview with Mr. Willem de Blok.