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to be treated, if the lesion is posterior and amenable to cryoablation, I would cryoablate it, but I would do that using multiple temperature sensing needles, so that I know that the therapy I'm giving my patient is going to be as perfect as possible.
In this regard, while some may say the cryoablation without MTS needles is good enough, my reply is that I personally have no interest in good. Some people counter that stance with the saying: "Better is the enemy of good." My feeling is that your result is either perfect or it's imperfect. Who wants their patient to have an imperfect result? Perfection is the name of the game. Hurting your patients as little as possible to cure them is also the name of the game. So yes, I foresee a future where all these small renal masses, quite frankly, are going to be treated by the interventional radiologist on a CT scanner that is equipped with AI. It is going to put the needles in the tumors, put the MTS needles down and freeze the tumors, effectively. Now, that's not going to be popular with any urologist, but it will be very, very popular with the patient. And it's not about you. It's about them.
(The alternative is forurologists to get into interventional
urology and being to use the CT scanner on their own for this purpose...but that is a topic for another day.)
F.N.: Do you believe that young urologists should continue to be trained in open surgery?
Prof. Ralph V. Clayman: Yes, I think that's reasonable. But you're not going to use it that often, and so it's a difficult thing. It's like asking you, after the Holmium laser came out and you could treat bladder stones with that, whether you think urologists should continue to be trained to sound for the stone and crush it up with a lithotripter. At this point you would say: "No, that's not necessary", because the chances of needing something like that are just nonexistent. Laparoscopy and robotic surgery are getting to the point where the chance of needing to convert is getting smaller and smaller. But, if you need to convert, it's nice if you know how to do open surgery. Now, the flip side of this is the fact that, if you're only opening once or twice a year, I don't think you're going to feel comfortable. I have to admit that as we did more and more laparoscopic surgery, and less and less open surgery, on the one or two cases where we needed to open during the year,
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