EAU15: Maximising minimally invasive surgery

“This is about our duty of care, to constantly strive to innovate and explore new technologies so that we can offer better treatments to our patients. This is about working together,” said Mark Emberton (GB). The themes of technological advance and multidisciplinarity recurred throughout the session, and all present agreed they were needed in all uro-oncological specialties.

“Robotic surgery will take over most indications for nephron-sparing surgery,” said Alexandre Mottrie (BE) in his lecture on kidney outcomes. He noted the quick rise in the number of robotic partial nephrectomies being carried out. In his view, robotic surgery is feasible, even in complex cases, as it has a good oncological outcome and an acceptable learning curve for the surgeon.

Peter Wiklund presented bladder cancer outcomes, and concluded that while OR time favours open radical cystectomy, complications, blood loss and rate of hospital stay tip the balance towards the use of robots. And while hospital costs could favour an open approach,he stressed that “calculating the cost effectiveness overall remains complex,” adding that social costs are not always taken into account.

Regarding prostate cancer, Francesco Montorsi (IT) advocated the use of robotic surgery, andpatient selection that makes use of technologies like MRI. “I know this is provocative butRARP is the real focal therapy for very young men who want surgery,” said Francesco Montorsi, which triggered a debate.

“This is about turning our attention away from the prostate, and actually trying to understand the tumour,” countered Emberton. In his view, innovation can only happen if there is a multidisciplinary setting. He talked about the advances in focal therapy and the evolution of the research to understand the biology of the disease.

His team set up a threshold. “It is like active surveillance,” he said about the approach, “but there we surveil the man, and here we surveil the tumour.” He presented the newest protocol that his team is currently working on, which is at the point of becoming a randomised study, for the best evidence-based treatment possible. Finally, he stressed once more the importance of imaging techniques for prostate cancer treatment.

“The future is almost impossible to predict, but I think it will be almost totally non-invasive,” he concluded.

The rest of the meetingwas dedicated to the evolution robotic surgery, as well as recent innovations and novel approaches. Interesting questions arose, such as the comparison between prostatic laser enucleation versus robotic and laparoscopy¸ and novel approaches to PCNL, among several other promising research areas.