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E.O.E Newsletter | www.huanet.gr
Sweden, after 1 to 2 months, I learned that a cardiac surgeon had got a donation and bought a robot for cardiac surgery. Then I managed to persuade them to borrow the robot every Friday. I did a prostate every Friday. So, this is how the whole thing started in 2001.
T.S.: Before using the DaVinci, were you a fan of minimally-invasive surgery? What were your thoughts and your experience on laparoscopic urological surgery?
P.W.: I was trained as an open surgeon but I was present when the big switch from open to laparoscopic surgery happened and I felt that this was a step forward to do minimally invasive surgery, absolutely. That was one also of the feelings that guided me to the robotic surgery, because that was for me the way to go from open surgeon into a laparoscopic surgeon with less effort, basically.
T.S.: After performing your first cases with the DaVinci, could you spot any advantages for the surgeon and the patient? Were these advantages more prominent on the long-term?
P.W.: As I told you, I saw the first model of the robot in a meeting and I sat down and I could do so many things so much easier with the robot (like suturing, with the wristed instruments) than as a laparoscopic surgeon. I immediately saw these advantages. There are some disadvantages, of course, with the robot also. For instance, you are a slave under your port placement. So, the way you put your ports is basically going to decide how easy is going to be for you to do the surgery. In the beginning, was more difficult , but now I know, of course, how to put the ports.. Because that’s for me one of the drawbacks of robotic surgery. If you, for some reason, put the trocars in the wrong position, so your angles are not perfect, then the surgery becomes much much more difficult.
T.S.: Could you imagine yourself becoming
a world leader in robotic urological surgery?
P.W.: No! Not really! That was not in my mind. I just felt that this was a way forward basically to do the surgery better and simpler. I became a leader because I was one of the first and I felt that relatively quickly, when I was invited to give talks. I was already professor at Karolinska at that time, so I already had a good position.
T.S.: You are considered the world leader and expert in robotic cystectomy with neobladder construction. Do you remember your first case? Could you share with us your feelings before and after your first case?
P.W.: Yes! That was a long time ago! My first surgery with neobladder construction was done back in 2003. Before that, I had done a lot of cystectomies as an open surgeon. So, I had a lot of training with different types of urinary diversions and neobladders. For 1 year I did only prostates with the robot. But after 1 year, I thought “now it’s time to do cystectomies”. I thought immediately that we should do the urinary diversion intracorporeally, because it was never in my mindset that we should make an incision and take everything to the outside. In my first case I tried to do exactly what I did in open surgery. I took out the bladder and the lymph nodes, I did the Studer and then I tried to pull it down to the urethra like we do in open surgery, but it was very difficult because there was a lot of tension. So, I think on patient number 3, I had the idea to change this. I pulled the intestine down to the urethra and I started with the anastomosis before actually creating the neobladder. That was for me a groundbreaking step, because once I understood that we start with that part of the surgery, then it became much much easier. We had a relatively slow start with cystectomies, because we had such a long waiting list for prostates.
F.N.: The removal of the bladder is one of
the most extensive procedures that are done
in the field of surgery. What’s on your mind before going in the operating theatre for the surgery of a complex and challenging case of bladder cancer?
P.W.: So, for me surgery is science, it is not art. I don’t like videos where they have classic music accompanying surgery. I don’t see surgery like that. For me surgery is scientific. You follow certain steps in a certain order and every time you do a step, you have an exact idea of what you are doing, why you are doing it and what it’s going to achieve. So, I can basically tell you anytime during the cystectomy how many minutes we have to finish the case, because , for me, I know that every step takes a certain number of minutes. I don’t think
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