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Μπορείτε να δείτε την συνέντευξη στο video αυτό. Διάρκεια 40’
Tεύχος 34 | Mάρτιος - Απρίλιος 2025
when you are in the car, it works. You can drive, but you have no idea about how it works. It will be more or less the same for us. It means that we will have to trust the system. It means also for the companies, that it will be much more complicated to innovate and to come up with this innovation, because of responsibility and legal issues. Finally, I think that single-use equipment it is, again, a huge improvement. It's a fantastic innovation and it gives the possibility to design different scopes. For many years, the major companies were producing only one model, one scope, because it was reusable. They were not able to design a small one, a big one, different channels, and different deflections. In terms of production, they produced one model and you had to use it for all your patients. With the single use, you can see that we start with different models. The companies are thinking differently. They are thinking "Okay, we need specific instruments to do this, and specific instruments to do that". So, we will have also these possibilities. Plenty of innovation will come. You will be very happy in the future, I'm sure.
T.S.: We have already discussed the perfect laser for stone disease management and for enucleation of the prostate. In your opinion, which is the perfect laser for treating UTUCs?
Professor Olivier Traxer: I must say that I'm very fortunate. I can use all the different lasers, Tm: YAG,
Holmium, low power, high power, and Thulium fiber. My favorite one is the Thulium fiber. Because in the Thulium fiber, due to the characteristics of the laser emission, the bleeding is much less compared to Holmium and Tm: YAG. I'm not sure that I'm doing a better job in terms of removing the tumor, but since the bleeding is much less, I'm not forced to irrigate too much. If it bleeds, you have to irrigate more to have a clear view. But if you irrigate more, the risk is to increase the pressure. If you increase the pressure, you will promote the intrarenal reflux. Like in stone treatment, if the urine is not infected, maybe it's acceptable, and we can maybe do that. But if we are treating urothelial tumors, we are not looking for intrarenal reflux. To reduce the intrarenal reflux, you need to decrease the pressure, and to decrease the pressure you need to decrease the irrigation. If you decrease irrigation, then the vision is not perfect, especially if there is bleeding. That is why I love the Thulium fiber. The bleeding is minimal and there is no need to force my irrigation. So, for UTUC treatment, that's my favorite one. Thulium fiber is also excellent for making laser incisions. It's a nice energy source for that purpose.
T.S.: You are responsible for a very popular endourology fellowship program. How do you feel about training and "creating" future experts in the field?
Professor Olivier Traxer: This fellowship is very essential. It is very important if you would like to improve your knowledge of a specific topic, to spend at least one year fully concentrated on this topic. The fellowship is probably the best way to get completely into the topic. At my place, the fellows of course can go to the operating theater two days a week. We do two full days altogether. So after one year, you can imagine that they have seen a lot of cases. They can also work with all the equipment. We are fortunate to have all the endoscopes, including reusables and disposables. We have all the lasers. We have 10 different lasers. They will know all the technology. Also, they are in contact with the companies. I think it is very important to be in contact with the companies and to talk to them about new equipment and to compare the equipment. At my place, also, when my fellows are coming, I "force" them to follow two University diplomas. One is on metabolic and medical management. I can tell you that when my fellows are coming, most of them don't know very well the medical management, stone composition, crystalluria, etc. After one year, since they complete this University diploma with my colleagues from Nephrology and Biology, they have a fantastic knowledge of this medical management and most of them can do it after that. At the same time, they follow a second University diploma in Endourology, where we are talking about all the technology, instruments, etc. This is a theoretical part of Endourology. I must say also that when the fellows are coming, they are super motivated. It is not like my residents, who sometimes are not so motivated. But when the fellows are coming, they are making a huge effort, because they are leaving their country to come to France, most of the time without a lot of money, to spend one year. I have no problem in terms of motivation. They are super motivated. They are exposed to clinical activities. They can go to the lab two days a week. I think this fellowship is very productive and essential.
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