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Interview with Prof. Maurizio Brausi - Surgery in uro-oncology - open surgery vs. robotic surgery
Professor Maurizio Brausi MD
Department of Urology, Ausl Modena
Nuovo Ospedale Civile-S, Agostino Estense, Modena, Italy
The topic today I would like to talk about is our meeting we had yesterday about uro-oncology. Our section, the ESO, was together with EROS, the section of robotic surgery, and just we wanted to hold a meeting just comparing the two techniques and to discuss the techniques and to discuss the techniques in a very, very open and nice way.
The attendees were many, more than 1000 people attended the session, and we had three debates, very interesting debates, on prostate cancer, kidney cancer and bladder cancer. In this debate we discussed about the better way or best way of doing surgery, comparing open surgery versus robotic surgery, and we took into consideration all the details, starting from the oncological result and ending up with quality of life and costs also.
It was interesting because we had a lot of discussions and the debates were very, very good and what happens and what is the result is that again, open surgery for instance in bladder cancer is the main street, is the main operation to do. It is still the standard. However, however, in this particular disease I am discussing about infiltrative bladder cancer, robotic surgery is important, and probably will be the main procedure in the future.
When we discussed this topic, we took into consideration also quality of life as I said. First of all, the recovery of the patients. Patients after robotic radical cystectomy recover very quickly, more quickly than in open, and blood loss during the operation is less with robotics than open, and then the complication rate sometimes is a little bit less. However, in some randomised trials which we like because you know we are comparing in a prospective way the same kind of patient operated with robotics and in open didn't show not much difference in oncological result, positive margins and lymph node retrieval, and recurrence rate. However, it was a little bit of difference as I said in blood loss and recovery of the patients.
So we think that in this particular disease, robotic surgery is not the standard yet, but it will become probably one of the most important procedures, and the reason is because of the costs also, because robotic surgery is expensive. In our institution, for instance, in Modena, one operation like this is more than €20,000 compared to €10,000 of open, so this also is an issue.
Just discussing about kidney cancer, kidney cancer we know that robotics, robotic surgery is very important for nephron-sparing surgery and however, in robotics, again, costs and the cost of robotic surgery is much higher than the cost of open surgery, and we discussed a little bit at the end, in a very special case, we have some cases where we have big masses in the central location in the kidney, and this big mass needs a lot of time in order to be removed. And since with robotics we have to clamp the pedicles, you know sometimes the time you have is not enough. So many times in these cases you need to be an open surgeon also. So, open surgery is still there even if, we must be very clear, robotic surgery in kidney cancer is appropriate for nephron-sparing surgery.
The take-home message is in prostate cancer, robotic surgery is going to be the standard. In kidney cancer, robotic surgery is used mainly for nephron-sparing surgery, and is probably one of the best ways to do. Third, in bladder cancer, muscle-invasive bladder cancer, open surgery is still the standard. We are waiting for new robotics which cost a little bit less in order to reduce costs, and then to improve our management of these patients.
Recently, there has been a lot of discussion with regards to better and effective surgical techniques in urological oncology such as open surgery versus robotic surgery. In this video, Prof. Maurizio Brausi discusses the debate session in EAU 2017 on the indications of open surgery and robotic surgery in various urological cancers such as prostate, bladder and kidney. He concludes that the evidence base for robotic surgery is still in a nascent stage and though it may become a standard care in prostate cancer, it is yet to fully establish itself in the management of kidney and bladder cancer.