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E.O.E Newsletter | www.huanet.gr
F.N.: With the advancements in percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), do you think that, in the future, endoscopic combined intrarenal surgery (ECIRS) will be generalised for the management of all complex kidney stones?
C.M.S.: This is a very good question, because I like to underline the diagnostic use of flexible ureteroscopy. Flexible ureteroscopy adds dynamic, real-time information to preoperative CT, because we know something about the elasticity of ureter and calyces, we can see if the stone is mobile or impacted, inside or outside the papilla. So, we can offer a personalized treatment to the patient, performing the “right” surgery. Under ureteroscopic guidance, we can move to percutaneous surgery choosing the better access and modulating all the steps on the clinical situation of the patient.
T.S.: Do you suggest Italy for someone who wants to follow a residency or fellowship program in Urology?
C.M.S.: Absolutely yes! We have a lot of centers where you can assist to all the treatments for BPH and/or stones. In our hospital we are doing 25 - 30 courses every year. We are also organizing every year the "Technology & Training in Endourology" Congress, where we are presenting a lot of live surgeries (16 live surgeries in 2024, with the possibility to be familiar with the best endourologists in the world). This is a good congress for all the young urologists. On the other side, it is also important to develop the technology, because nowadays we have to be a bit more like engineers. When you are using a laser, you have to know exactly all the features and physical characteristics, because it's also a matter of responsibility. The vision of the young urologists should be not only on the technique, but also focused on the knowledge of the characteristics of these fantastic, yet very dangerous, energy sources, like the lasers. In terms of responsibility to the patient, you have to know exactly "the car that you are driving". This is what I always did in my urological life. Additionally, you can think about something that you need and it's not in the market, and try to have some companies working with you to increase the level of your surgery. For this reason, I created a stone basket, named Dormia® DualPerc, in which we have one rigid basket and inside, if we remove the internal part, we have a flexible basket. It is just the right basket for endoscopic combined intrarenal surgery.
F.N.: In your opinion, how important is the knowledge of physics and mechanics, in order to better understand the diseases and procedures of Endourology?
C.M.S.: It is fundamental! For instance, you might have one laser, in which you can set the different parameters in totally different ways, obtaining dusting vs. fragmenting effects, or coagulative vs. dissecting effects. This is the reason why you have to know exactly what you are doing. I don't like all the presettings in the lasers, because I think that when you are driving a car, you have to be able to choose what you need in that particular moment. You also have to adapt to what happens during the surgery, maximizing both efficiency and safety.
T.S.: You are the inventor of a very famous and trending device, the Dormia® DualPerc, a new basket for PCNL and ECIRS.
Could you please briefly describe us the story behind this invention? How do you feel
when your colleagues adopt it?
C.S.M.: It is a long story, because we started this pathway in 2014. Due to the COVID-19 pandemic, and for many other reasons, we finished last year, in 2023. My idea was to have a basket which could be used both in rigid and flexible nephroscopes during ECIRS, because I needed it many times in my daily practice. When I checked the collecting system for residual fragments at the end of ECIRS, if I identified a stone with the flexible nephroscope I had to ask for a further basket for flexible ureteroscopy. Therefore, we started to discuss with Coloplast engineers about the possibility to create a unique basket for both antegrade scenarios, rigid and flexible. They were very good in building this basket. Dormia® DualPerc is a rigid basket, like the normal basket for PCNL already in the market, but the big advantage is that dismounting it there is a 28 cm longer internal flexible part. You can use this basket in every kind of nephroscope. The diameters are 4.8 Fr and 7 Fr, being the standard one now in the market 10 Fr. When some colleagues are using the basket that I invented, I'm very proud of this. I am very happy, because I hope that in the future, somebody can remember me not only as a urologist, but also as a technician, for my effort to improve percutaneous stone surgery.
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