Day 1 Report: Young Urologists and the future of Robotic Surgery

25 September 2017

The motto of the 14th Annual EAU Robotic Urology Section meeting is “Experts of today vs. rising stars of tomorrow”, and the opening day of the meeting immediately introduces us to those rising stars. The Junior ERUS – Young Academic Urologists meeting asked about this upcoming generation: “Will they be using new robotic systems? Will they be ‘technology freaks’? And will they become super-specialised organ surgeons?”

ERUS17 kicked off on Monday, September 25th in the Bruges Concert Hall, which doubles as a congress centre. The charming postmodern style building hosted the full-day ERUS-EAUN Meeting, while the Junior ERUS – YAU meeting and ESU Courses took part in the NH Hotel across the street.

Examining the future of robotics and technology

Dr. Alessandro Larcher (Milan, IT) presented the plans for an ERUS curriculum for robotic partial nephrectomy, based on the successful programme for radical prostatectomy. After weeks of VR, dry and wet lab training, followed by console training and scoring each phase, surgeons can master the procedure before operating on patients. This can compensate for the relatively low volume of the robotic partial nephrectomy, which is on average 60 per centre per year for the 15 most high-volume centres for this procedure.

The 80 delegates present that morning were then treated to an extensive overview of the robotic systems that are currently in development, some just around the corner and others better treated with caution. Dr. Stavros Tyritzis (Athens, GR) pointed out the explosive growth of the sector, going from $3.2 billion in 2014 to a projected $20 billion a mere six years later.

“As surgeons, we are in expectation of several features in future robotic systems,” Tyritzis started, listing tissue recognition/haptic feedback, augmented reality/image guidance, a smaller footprint, affordability and automation. “The new systems need to be as good as the DaVinci systems that we have, or better, and offer new features in order to become widely adopted.”

The multitude of (planned) systems that were then presented each had unique selling points, some focusing on affordability, some on a mobile form factor, miniaturisation and almost all trying to offer surgeons a complete, multifunctional package. Human and even animal trials were still far off in most cases, with some robots first being presented in 2014 and still not available.

Beyond surgical systems, technology has a lot to offer the future urologists. Dr. Ruben De Groote (Aalst, BE) presented a selection of recent or upcoming technological breakthroughs, including the 3D-printing of soft tissue models in order to rehearse operations, software tools like Alexa and Watson that simplify organisational duties and help surgeons make informed choices.

Live Surgery and audience interaction

The morning session ended with a live surgery demonstration by Dr. Achilles Ploumidis (Athens, GR), who performed a rather unusual partial nephrectomy with the assistance of the Firefly visual guiding system.

Dr. Geert De Naeyer (Aalst, BE), chairman of the YAU Robotic Urology Working Group and Chairman of the Junior ERUS-YAU Meeting at ERUS17 was pleased with how the programme unfolded: “We had a perfect Junior-ERUS meeting, with very interesting topics, and practical advice for young urologists. Particularly the interactive case discussions on the management of complications drew a lot of comments from the audience.”

“This year, the live surgery was streamed through the internet rather than satellite transmission. We were a little apprehensive about this, but it went well and it has potential. Moderation was a little different. Due to the 30 second lag, we used [mobile instant messaging platform] Whatsapp to get in touch with the surgical team, rather than simply speaking directly. This made interaction a little more complex.”

“Achilles did a great job on a difficult case, clamping two of the three arteries. It looked perfect as he was finishing up and the session ended.”