Prof. Alexandre Mottrie (Aalst, BE), chairman of the EAU Robotic Urology Section (ERUS), talks on the challenges in treatment strategies, the goals of ERUS and trends in minimally invasive surgery.Data from robot-assisted surgeries are still not very conclusive or debatable as to their efficacy, side effects and costs. What in your opinion is the biggest advantage for the patient when it comes to robot-assisted surgeries?
Robotic surgery is still an emerging technique, so it is logical that data available so far are still immature. Even when immature, data tend to show several advantages of this technique over open or laparoscopic surgery for several indications. The biggest advantage of robotic surgery for the patients is the fact that the robot allows the surgeon to perform meticulous dissection and ultraprecise manoeuvring in a minimal invasive way. This leads to less damage and the recovery of the patients is quicker.
The ERUS meeting will highlight the latest techniques and examine issues in robot-assisted urological issues. What are the benefi ts of this meeting for urological surgeons?
ERUS offers not only live surgery performed by top experts, but during the congress there will also be ERUS/ESU courses, state-of-the-art lectures and round tables. There will be a lot of updated information on robotics in urology in such a compact meeting. The main focus is live surgery so participants can see for themselves the advantages of this wonderful technique for many indications. ERUS also offers a platform where colleagues can meet in a very informal, convivial way.
Robot-assisted procedures are costly and are still limited to big expert centres. Do you expect these techniques and procedures to eventually spread or trickle down to more hospitals in the future? If so, what are the main reasons for the growing interest or lack thereof?
Studies have shown that macro-economically, there is cost-efficiency provided there are at least 150 proceduresperformed yearly pro robot. The number of robots and the type of hospitals where they are acquired varies amongst different countries. The interest for this technique is widespread but budgeting on micro-economical scale is still a problem. ERUS now has a working group led by Dr. Witt that is looking at these issues.
It has been argued that it is not the technology, but the surgeon or doctor’s expertise that makes a crucial difference whether a treatment is effective or not. If so, do you expect the push for technology to eventually decline in favour of a more human-led treatment strategy that is less focused on techniques?
Not at all. Technology offers surgeons to do better than what they were able to do with bare hands. Of course, a “fool with a tool, is still a fool,” as the saying goes. When new technologies are introduced, proper training is mandatory to ensure safety. ERUS as the EAU’s working group on robotic surgery is working on specific training programmes and robotic curriculums. I am convinced that EAU can play a major role to ensure validated training for robotic surgery.
You will be leading a partial nephrectomy procedure with Firefly. Can you tell us a bit more about this procedure and its benefits for both the surgeon and the patient?
Partial nephrectomy is a great indication for robotic surgery. The latest innovation in robotics is the possibility to use fluorescence. This is a safe way to identify which part of the kidney is avascular during segmental clamping. In this technique, indigo-cyanine green is activated through near-infrared light. Vascularised tissue colours green and so the area of avascular kidney can be defined and judged whether selective arterial clamping is feasible.
The 11th ERUS Meeting will take place in Amsterdam on 17-19 September, 2014.
Please visit the Meeting Website for the most up-to-date information including the preliminary scientific programme.
You can still submit abstracts until 16 June, 2014.