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Classical laparoscopic radical prostatectomy means also a very, very good, excellent procedure. Again, you know, the robot is the future. There are so many other advantages, like teaching. The teaching with a dual console is much, much easier than in laparoscopy. The telesurgery, which is possible, the firefly model - all these little advantages together make the surgery easier and more comfortable for the surgeon. We should always remember that robotic-assisted laparoscopic surgery is just another version of - a better version of conventional laparoscopy. Finally, I would like to underline that I have taught a lot of surgeons in my life, and I think for classical lap, you need a special talent, definitely. And some surgeons, they have it. But not everybody! If you teach robotic-assisted laparoscopy, you see that much more surgeons can translate, their thinking and knowledge, into good surgery. Overall, there are much more good robotic surgeons than classical lap surgeons.
F.N.: In your opinion, is it better for someone to start their training with robotic surgery directly, or do you think that having laparoscopic skills can facilitate a smoother transition to robotic surgery?
Professor Jens-Uwe Stolzenburg: You can do robotic surgery without being taught in classical lap, but it's easier if you are a laparoscopic surgeon, to move to the robot. Think for example port placement! If there are adhesions, you start laparoscopically, you release the tissue, and then you put the ports. So, in my opinion, it's easier if you are experienced in lap and then you go to the robot. But at the end, I think it's important that you operate. No matter how you have to operate! And then you collect experience, and this helps whatever you do.
F.N.: What is the current role of artificial intelligence in robotic-assisted surgery? Do you believe that, in the future, the robot will be able to independently execute certain steps of a surgery?
Professor Jens-Uwe Stolzenburg: That's a very good question, and we could have a symposium about it! So, that I think that the future is not really clear. The only thing which is clear is that we will have artificial intelligence. Let's consider the 3D modelling for example. You know, we are performing a randomized trial comparing robotic-assisted laparoscopic partial nephrectomies, with and without 3D modelling. At
the moment, we have problems to match the situs with the 3D picture, if we do have the 3D Modell in the field of view oft he daVinci. Hopefully this can be done with the aid of artificial intelligence in the future. Furthermore, think about diagnostics and applications of artificial intelligence in prostate cancer biopsies! And so there will be a lot of fields where we use it, and especially the younger generation, has to deal with it, because it will definitely help to make the diagnosis, to create treatment paths for patients, and, of course it will facilitate the surgery itself! In my heart, I'm a surgeon, and I think especially the combination of artificial intelligence, with 3D modelling and with the robot is a very good combination which will help to improve our outcomes in the near future!
F.N.: Are there any surgical issues in Urology today where laparoscopic surgery is more suitable or effective than robotic-assisted surgery?
Professor Jens-Uwe Stolzenburg: If you do a varicocelectomy, I would say that's in favor for classical laparoscopy. What's the point of opening instruments of 1,000 euros, if you are going to do a varicocelectomy? But as soon as you have a robot, you will start to do everycaserobotically. That'swhatIseeinothercenters. Of course, you could argue that there are more easy cases, but these are the cases where you learn. You know, when I moved from open to laparoscopy, I didn't like to do one case open and one case lap. I decided that every prostatectomy from that moment would be done laparoscopically. I would recommend to do the same when you have the robot. Just do every case with the robot and you will collect experience. You become an experienced surgeon by doing everything with the instrument that you have. There is not a sharp barrier between laparoscopy and robotics.
Tεύχος 35 | Mάιος - Ιούνιος 2025
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