Page 33 - NEWSLETTER_33

ΣΥΝΈΝΤΈΥΞΗ
F.N.: You have performed many live surgeries. How do you feel before starting a live surgery? How important are live surgeries for educational purposes?
C.M.S.: This is a very good question. There was a big discussion on this topic in the last years, because of ethical problems. I think that live surgery is a very good way to teach surgery, but it depends a lot on the surgeon who is doing the surgery, and also on the environment and the organization of the event. First, we have to choose the right patient and prepare our Department for giving the surgeon all the equipment used in the daily practice. On the other side, the surgeon must be really calm and rationale, facing the live surgery as one of the surgeries in the own hospital. Sometimes it's difficult, especially when difficulties, complications or something unexpected arise. In this case, I believe that the surgeon has the responsibility to focus on the patient, without thinking about the live surgery. Because if you are doing a lot of things, sometimes something happens. What is the difference between live and prerecorded surgery? It is that if something wrong happens, you can also show how to manage it, and this is the big advantage. You can present in a prerecorded video a complication, but it's different, because in prerecorded videos you have time to think. In live surgery you have to decide in a few seconds or a few minutes and you have to give the best suggestion to the people, especially if they are urologists. As usual, when you are skilled and experienced, you know immediately the solution. There might be ten different solutions, but you know which is the right one and immediately go after it. You should not let anxiety drive you when something goes wrong, because this is dangerous for the patient. Also, there is a big problem with the informed consent of the patient, but regarding this problem the organizer of the meeting plays a very important role.
T.S.: In your Stone Center in Torino, you perform all procedures for stone management, such as ESWL, URS and PCNL. Do you believe that in the future all these treatment modalities will be still available? How far are we from treating all stones with flexible ureteroscopy?
C.M.S.: Ureteroscopy is a fantastic way to treat stones, the limit being the accessibility of the ureter, because its anatomy is not always compliant to the retrograde access. A further and relevant limitation of ureteroscopy is the complete removal of stone fragments. Stone- free means no residual fragments at all, even of one, two, three or four millimeters. So, I believe that we
Tεύχος 33 | Iανουάριος - Φεβρουάριος 2025
have to be very serious and honest when evaluating the results. This is the reason why I think that when you are approaching the stone treatment, you have to be good in flexible and semi-rigid ureteroscopy, in percutaneous surgery, and you must have also ESWL in the armamentarium of your center, to be able to offer the right solution to the patient. Flexible ureterorenoscopy is a very good surgical option, but is not the universal solution for any urolithiasis. A 3 cm pelvic stone or a staghorn calyceal stone are quite impossible to be retrogradely treated in one step. RIRS might require two or three steps, always maintaining a double J stent, with multiple hospital stays and anesthesias. I think that percutaneous surgery for large, complex or staghorn stones has a big role today, also in children. We have to understand that we must adapt always our instruments to the patient, and not vice versa.
33