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T.S.: What was your reaction when minimal- invasive procedures started trending in Urology? Did you immediately start performing laparoscopic surgeries back then?
H.vP.: No and I was pretty sceptical. You might be aware of a couple of papers that I have written, also a couple of presentations that I have given and a number of invitations that I have got in the beginning of the robotic era, when people invited me to come and speak and argue against minimal invasive surgery. When they came up with “the sky is the limit” for robotic and laparoscopic surgery, I said “This is all fine, but they can’t do everything”. For instance, I thought, if you have an inguinal hernia mesh repair, you are going to have a problem to introduce your instruments. When you have had a Millin prostatectomy, it is going to be hard to do a minimal invasive laparoscopic radical prostatectomy. When you have radiation therapy and you want to do a salvage prostatectomy, this is not going to work. So, I thought there will always be place for open surgery. I have come back on that and now I think that an expert robotic surgeon can do almost everything. I don’t speak about the intracardiac vena cava thrombus, but a smaller vena cava thrombus can be done with robotic techniques today. Even bladder replacements are now done in intraperitoneally. Also, difficult partial nephrectomies can be done. They can do almost everything that open surgeons can do. But there is still a small number of surgeries, where open surgical skills are needed. So, I was sceptical at the beginning. I never performed a single laparoscopic surgery! I have been sitting behind the console of the robot just for “tasting”, but I have never operated a patient robotically. I didn’t like endoscopy, I didn’t like to do TUR of the prostate and ureteroscopies when I was in training, I didn’t like to extract stones. I liked to cut and open and to do open surgery. But I am happy that my successors now can do about anything in a minimal invasive way. It is an excellent evolution for the patients. The results are absolutely equal. There was a paper recently comparing open and minimal invasive radical cystectomy. The oncological results have been disputed but the study showed that there are exactly equal and the patients obviously do much better and recover much quicker after these minimal invasive techniques.
T.S.: Which where your thoughts when you first heard about the robot? Could you predict its wide adoption by urologists back then?
H.vP.: I have tried to have the robot here in Leuven as soon as possible and I was really happy to have younger staff members who really loved it. As I said, I have never done it. Some people told me that I needed to learn it, because this was going to be the future. My answer to them was that I knew my results on the thousands of radical prostatectomies and the partial nephrectomies that I performed. I like to have the kidney in my hand and to feel the prostate. So, I have not been doing it with the argument that, if I need to do an, as good radical prostatectomy with the robot, as the one that I do skin to skin in 1 hour and 5 minutes in open surgery, then I need to train for 3 or 4 years. This is not worth it, because I will be retired by then. So, I never started it. This choice has also proved to be beneficial, because it forced my younger people to really take it on and develop it successfully.
T.S.: In that point I would like to add an
extra question. You have been referred many times in your engagement with the European Parliament. Could you please describe us
when and how did this engagement with the European Commission start and how did you combine it with Urology?
H.vP.: I went into the Parliament in 2015 and this is also when I stepped down from the position of the Chairman of Urology, here in Leuven. In Belgium, when you reach at a certain age, you are not allowed to continue doing surgery in the University Hospital. So, I suddenly had a lot of time. It was easy for me to start up my introduction in the European Parliament, at the side of an MEP who was next to me for two weeks. Once you get there, you realise that if we just speak among eminent urologists, we do not achieve anything in the political world. You need to address the policy makers and make them understand of what we are doing. The interaction with the MEPs has come to a stage, that when we want to do something on prostate cancer, for instance, we ask them whether they can host us in the European Parliament for an event, that we would like to organise in October, for example. Because we know the people in the Commission, who are responsible for the rules and the recommendations of screening. If you know these people, you can really ask them to help you. And they will! This means, more or less, that they support you. The Commission is a very complex organism. I remember back when Ursula von der
Tεύχος 25 | Σεπτέμβριος – Οκτώβριος 2023
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