Page 40 - NEWSLETTER_35

E.O.E Newsletter | www.huanet.gr
40
T.S.: Your research has led, among others, to the understanding of the surgical anatomy of the urinary sphincters. Do you believe that deep understanding of the surgical anatomy has really an impact on the outcomes of a surgeon?
Professor Jens-Uwe Stolzenburg: I do believe it. It is essential to understand what you do, and especially the anatomy of sphincter muscles, of the nerves, etc. The pelvis is a very narrow space where we operate, when we do for example a prostatectomy or a nerve-sparing cystectomy, so we have to know the anatomy. Then, we are able to dissect the planes and to preserve what we want to preserve. Actually, I would do an examination on anatomy before somebody could start to do surgery.
T.S.: You were one of the first surgeons
who introduced the fascial planes of the neurovascular bundles during a nerve-sparing radical prostatectomy procedure. Are you convinced that a good intrafascial nerve-sparing technique can significantly impact the post- prostatectomy potency and continence rates?
Professor Jens-Uwe Stolzenburg: Absolutely! It is an interesting story. At that time Mani Menon did robotics and we did classical laparoscopy. We published two papers nearly exactly the same time. His paper was titled "Veil of Aphrodite", and our paper was titled "Intrafascial nerve-sparing", which are the same. At the same time a laparoscopic surgeon and a robotic surgeon described the anatomy in order to do a maximum nerve-sparing. This also indicates that the anatomy defines what we are doing, not the instrument or the surgeon. We definitely have to follow the anatomy. It has been proved many times by many publications that an intrafascial nerve-sparing is a better nerve-sparing technique than the standard nerve-sparing and the patients that we operate have a higher chance to be potent after the surgery.
T.S.: In your opinion which is the most important factor, that a surgeon can take care of, for avoiding post-prostatectomy incontinence?
Professor Jens-Uwe Stolzenburg: This has also been proved by the literature. Of course, the preservation of the sphincter muscles is important. You know that there is the striated sphincter and the smooth muscular sphincter that we have to preserve, following the anatomy of the prostate and dissecting directly on
the surface of the prostate. But we also know that the early continence of patients who underwent a nerve- sparing prostatectomy is better. That means, when we do a nerve-sparing procedure, we also preserve nerves running to the sphincter. This is why we also preserve nerves in patients who are not potent anymore and so it wouldn't make sense to preserve the nerves for potency. We preserve the nerves because the continence rates after the operation are better.
T.S.: But if you could name a single factor among all the factors that impact the continence
rates, what would it be? For example, some surgeons believe that the most important factor is the length of the urethra, some others the neurovascular bundles, etc.
Professor Jens-Uwe Stolzenburg: We can't preserve the neurovascular bundles in a very aggressive tumor. Rule number one is, don't use energy when you cut the sphincter, because the energy can also destroy the sphincter muscles, not only the nerves. As I said, the nerve-sparing technique influences the early continence of the surgery, but we can't preserve the nerves in an aggressive tumor. So, this can't be a factor for all the patients. Another factor is the length of the urethra, but we have to be careful about what we are discussing. The part of the urethra which is responsible for the continence is the sphincteric part, it is not the inner urethra, that we can preserve “longer” when we do the prostatectomy.
F.N.: What other advancements or new technologies do you expect to see in the near future for robotic-assisted surgery?
Professor Jens-Uwe Stolzenburg: We know that the generation 5 is on the market, with the tactile feedback. They started to launch this in the U.S., so this is hopefully an improvement of robotic-assisted surgery. The second is the single-port procedures
ΣΥΝΕΝΤΕΥΞΗ