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some special skills for laparoscopy, and that's why I'm quite fast. But being a good surgeon is not only about knowing how to use the instruments, you have to make decisions in milliseconds: “Do I go there? Do I go there? Do I go there?” And of course, you need a little talent to do this. But again, I would say, of course, I'm very fast doing surgery. But that's not the quality criterion. The quality criteria are only the outcomes that we have. If these are good, then you are a good surgeon!
T.S.: You are one of the first Urologists who used an extraperitoneal approach for laparoscopic radical prostatectomy. Why extraperitoneal laparoscopic radical prostatectomy? What
are the benefits over the conventional transperitoneal one?
Professor Jens-Uwe Stolzenburg: I would like to make clear that the first one who performed an extraperitoneal laparoscopic radical prostatectomy was Renaud Bollens, but me and my group we published the first major series of extraperitoneal laparoscopic radical prostatectomies in very early times. So of course, when you don’t go intraperitoneally, there are advantages. But at the end, I would say it doesn't matter if you go extra or trans. In my experience, when I do classical lap, the extraperitoneal access is faster, minor bleedings can tamponade, the recovery of patients is a little bit faster and so on. And it's interesting that now we have
the single port robot, the DaVinci SP robotic platform. And these surgeons who are doing prostatectomies with this new robot, they go extraperitoneally. They go through a little incision directly to the prostate. And that's obviously a big advantage! But at the end, I would say it doesn't matter if you go trans or extra.
T.S.: You can perform a laparoscopic procedure, such as a radical prostatectomy, quickly and efficiently. Why did you decide to move to the robot?
Professor Jens-Uwe Stolzenburg: Oh, I could answer to this question for two hours or even longer. So, there are different answers. Answer number one is, it's much more relaxing for the surgeon. You know, there is a great amount of physical stress when you perform classical lap. If you do a laparoscopic anastomosis on the robot, you're sitting on the console. You're absolutely relaxed, and you can suture very precisely. And we also have the movability of the instruments, which has the seven degrees of freedom, like our hands, which gives a lot of advantages. However, this does not automatically translate in better outcome. For me, it's proven for prostates, that the nerve-sparing part is really better with the robot. Some years ago, we did a multi-center blinded randomized trial, and it has been proven that the nerve-sparing is better with the robot, but not the continence and the oncological outcomes.
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