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It will always depend on experience, indications, patient characteristics, tumour characteristics, the surgery we do, the multidisciplinary approach. It is not the robot itself; it is all together. So, I think that experience will be always at the base. We can’t replace experience with the robot. It will be always behind pushing us to achieve a good result. What do I mean with this? If you are really skilled in lap and you are obtaining very good outcomes in lap, not having the robot doesn’t make you worse surgeon. If you are really skilled in open surgery, for sure your stays are longer, but the goal is to achieve the outcomes, the cure and the better results. So, the robot is a revolution. It is quite comfortable for us to sit there and operate. The precision, the dexterity and the way that we can do some things have improved. But always this must be done with clear indications, good follow up of our patients, training and expertise.
T.S.: The next question is very specific, but it’s a trending one. What are your thoughts on different robotic platforms? Can they compete with the DaVinci right now? Can you predict their future?
M.R.: Look, at my department we have the DaVinci and we have Hugo, so I can’t tell you about others, although here at the University of Barcelona we are testing a new robot, so we are helping ingeniers etc in the implementation of this robot. The truth is that DaVinci has been there for such a long time and the new platforms are more flexible platforms. I think that this is something we need, more flexible platforms. The new robots that are coming perhaps improve on that. But we need to maintain the precision of the instruments, we need to maintain the high resolution of the vision. I think that it’s really nice having new platforms that will open the competition and they will open the way to improve the outcomes. When you are alone in the market you are not pushed to improve your outcomes. At the moment you have other products coming, then all of them should compete for being the best. This will give us a second revolution in robotic surgery, because all of these platforms should fight for being the best. Τhis will take into account some of our requests for improving dexterity of the instruments or for example something that we have lost without realising , the haptic feeling. We have lost completely the haptic sensation and we need to recover from that. I am sure that all these platforms will change the world of robotic surgery, because they should force each other to become better.
T.S.: Unfortunately, in the field of Uro-Oncology some malignancies have bad prognosis and they progress to end stage disease. Except from the clinical management, how difficult is tο stand next to a urological patient with end stage disease, when it comes to psychological support?
M.R.: Look, this is one of the most difficult things. I told you that I am in love with Urology, because you are a surgeon but also you are a doctor. You are with the patient from the very beginning to the end. I am treating metastatic patients and I am facing end of life. I have learned a lot from that. First, you need to be trained on that, you need to have skills on that. Because, that moment is quite tricky and you should understand that you need to have a very open and honest communication with your patients and their families. You need to understand that you should give them emotional support, that you should be prepared to work in a multidisciplinary way with palliative care tips and also you should take care not only of the complications but also the emotions of the patients. You should be there, by his or her side, just to bringing them support for facing the last part of their life. Also, it is important to take care of caregivers and families, because at the end of life they are also quite important and all families are struggling with the situation. It is not a situation that only involves your patients, it involves the patients and all the people around them, so you should take care of them also. I think that the psychological support for the end-of-life patients, in very advance oncological diseases is quite important and we should learn how to do it. We should be trained. If you want to treat metastatic patients, you should do it with a proper training.
T.S.: The Hellenic Urological Association recently created its own Patient Office. According to your experience with the EAU Patient Office, how important is it to engage patients in different activities of the EAU? What should be the ideal role of any Patient Office?
M.R.: I think that the Patient Office is something very important for a scientific society. For example, I was president of the Catalan Society of Urology from 2018 till 2022; and one of the first things I did was to build the Patient Office. Because I think a scientific society has the responsibility of giving the patients honest, reliable and scientifically correct information. So, as scientific society we are the best source of information
Tεύχος 24 | Ioύλιος-Αύγουστος 2023
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