Live Surgery at ERUS16: Nerve-sparing radical prostatectomy

Tue, 26 Jul 2016 • Loek Keizer

Preparations are being made for ERUS16, the 13th Meeting of the EAU Robotic Urology Section. With the closing of abstract submissions, the scientific programme is being finalised and speakers are preparing for their talks. ERUS16 kicks off on September 14 in Milan with a special day for young urologists.

A large part of the ERUS16 Scientific Programme relies on live surgery: demonstrations of robotically-assisted procedures in this fast-evolving field of urology. Six sessions are devoted to both live and pre-recorded “semi-live” surgery, encompassing a large variety of procedures, techniques and expert surgeons. We spoke to Prof. Markus Graefen (Hamburg, DE) who will be performing a nerve-sparing radical prostatectomy.

Refining a technique

“I will perform a transperitoneal approach, without ligation of the dorsal vein prior to dissecting the prostate,” Prof. Graefen said of the procedure which is scheduled for Friday, September 16.

“Depending on the extent of the cancer, we will perform a bilateral intrafascial nerve-sparing procedure with intraoperative frozen sections (Neuro-Safe). We will be dissecting the urethral stump into the prostatic apex in order to gain functional length (FFLU-technique).”

“Our technique is much influenced by Dr. Patel’s approach. A few differences are the strict orientation for the beginning of the nerve-sparing procedure on the rectal side. This allows an easy reproducible intrafascial nerve-sparing procedure most of the times.”

As techniques evolve to follow technological breakthroughs, Prof. Graefen reflects on the scope for improvement in his approach. “There is still room for improvement when it comes to the indication for a nerve sparing procedure. As imaging techniques improve, the necessity of an intraoperative frozen section might be lower in the future.”

The importance of live surgery

Prof. Graefen first visited the ERUS meeting in 2010, when it was in Bordeaux. Impressed, particularly by the variety of live surgeries on offer, Graefen hosted the 2011 meeting in Hamburg. “This was a very important meeting for us, as robotic surgery was not very common in Hamburg those days. But with the organization of the ERUS meeting our hospitals’ rates of adoption of robotic surgery, especially for radical prostatectomy, was clearly accelerated."

On the educational value of live surgery, Prof. Graefen is clear: “Live surgeries allows offer something to learn. I like them more than edited videos as it is interesting to see the troubleshooting in case it is suddenly required. Live surgery is of great educational value.”

ERUS16 will take place in Milan on 14-16 September, 2016. In addition to live surgery, the meeting offers robotic hands-on training (for beginners and experienced surgeons alike), courses by the European School of Urology and the Junior ERUS - YAU, a special programme for young urologists. Registration is still open, with special rates for EAU members, residents and nurses.