EAU Exchange Programme: A transformative experience with new techniques and learnings

This conglomerate of AP-HP includes nearly 40 hospitals with eight dedicated to urology. Our visit focused on one of the largest urology departments renowned for its extensive use of the da Vinci Xi systems and innovative surgical approaches.

Observing a variety of robotic surgeries enhanced our technical skills in robotic-assisted procedures. The high volume of surgeries allowed us to see a broad range of urological applications for the da Vinci Xi robotic systems.

The availability of two da Vinci Xi systems and their use in 70-80% of urological procedures at AP-HP highlighted a significant difference. We were particularly intrigued by artificial urinary sphincter implantation where the device is placed around the prostate. This contrasts with the typical placement around the bulbous urethra, offering better stability and reduced risk of urethral erosion.

In contrast to the traditional open approach, robotic-assisted periprostatic artificial urinary sphincter implantation boasts shorter operative times, minimal blood loss, reduced incidence of complications, and comparable functional outcomes.

Additionally, the organisational structure supporting high-volume cadaveric kidney transplants and specialised care through a dedicated transplant ward showcased a more integrated approach to urology and nephrology than typically seen in our country.

The programme significantly broadened our perspective on the importance of interdisciplinary collaboration and advanced technology in urological care. At University Hospital La Pitié-Salpêtrière, we engaged in enlightening discussions with global peers. We had comprehensive dialogues with doctors from China, Japan and South Korea, and learned more about their advancements in robotic surgery technologies, including domestically developed surgical robots in China and pioneering techniques in Japan.

Dr. Zhenjie Wu, a Chinese physician, dedicated himself to refining his surgical expertise, conducting radical prostatectomies using the innovative Shurui single-port robotic surgical system, a product proudly made in China. Japanese doctors emphasised their focus on basic research, such as establishing animal models for clinical diseases and analysing patient tissue samples. In addition, South Korean doctors are heavily involved in big data analysis, integrating artificial intelligence (AI) and database research into their studies.

Interacting with peers from diverse cultural and professional backgrounds not only enhanced our communication skills but also deepened our understanding of global medical practices, patient care standards, and research methodologies.

The visit to Amsterdam UMC and the NKI-AVL was equally enlightening. These institutions specialise in highly focused surgeries, including the use of prostate-specific membrane antigen (PSMA)-radioguided surgery for sentinel lymph node excision for prostate cancer patients. This technique, which successfully locates and removes about 90% of suspicious lymph nodes during surgery, is yet to be introduced to our country.

Amsterdam UMC is also renowned for its expertise in transgender surgeries. During our time there, we witnessed two cases of female-to-male transgender procedures, where collaboration between urologists and plastic surgeons resulted in the creation of a penile structure through the rotation and tubularization of a flap harvested from the lower abdomen.

One memorable moment was during a surgery at the NKI-AVL, where we observed a robotic radical cystectomy followed by an ileal conduit reconstruction using a robot-assisted intracorporeal technique. The precision of the surgery, combined with the teamwork and the seamless integration of technology, was not only inspiring but also a clear demonstration of the potential for surgical innovation. This experience solidified our belief in the transformative power of robotic surgery in urology. The high degree of specialisation and the concentration of patients for specific surgeries at the NKI-AVL illustrate a profound dedication to surgical precision and expertise.

This exchange programme was transformative, significantly enhancing our professional skills and broadening our perspectives on patient care and surgical efficiency. We are grateful to Prof. Morgan Rouprêt (FR), Prof. Jeroen van Moorselaar (NL) and Dr. Laura Mertens (NL) for their leadership and the insights shared by our international colleagues from South Korea and Japan. We also extend our gratitude to the EAU Exchange Programme.

We look forward to integrating these new skills and insights into our practice, aiming to contribute to advancements in robotic surgery and patient care at our institution. We sincerely thank the organisers and all the participating professionals for their mentorship and friendship.

This programme not only sharpened our skills but also forged international connections that we deeply cherish. The journey was a profound reminder of the universal pursuit of medical excellence and compassionate patient care across borders. We hope that the TUA and the EAU will continue to foster this valuable interaction and exchange.