Page 38 - NEWSLETTER_36

E.O.E Newsletter | www.huanet.gr
38
was a relatively short-lived time in my career where I was, you know, a laser expert. But we were very good at determining what role it did have, and in other areas what role it did not have. Because people were promoting it for everything, including BPH. Now I know it does have a role, but the lasers we had available at that time, the wavelengths, etc., clearly did not. So, people were doing promotional sort of things. I actually wrote more papers about what lasers were not good for than for what they were useful.
F.N.: What were your initial thoughts when minimally-invasive surgical approaches, such
as laparoscopy and robotic-assisted surgery, first emerged in the field of urological oncology? Do you believe that in 2025, they really have benefits over conventional open surgery?
Prof. Joseph A. Smith: Well, this is a two-part question. Initially I was a skeptic. There were a handful of people who were promoting robotic surgery. I didn't think that it was going to have any advantages. The reason I became involved was that I thought someone who was a recognized expert surgeon in open surgery needed to learn the robotic surgery to prove that it was no better. That was my initial role. I became convinced that it really wasn't that much better, provided that someone really was an expert at the open surgery. But you know most of the people who were doing open oncological surgery were not doing high volume numbers, weren't highly expert and I don't think that they were really getting that
good of a result. Conversely, people could much more routinely obtain adequate results with the robotic surgery. There were some people who thought that the robot leveled the playing field and made some of the differences between expert surgeons and less accomplished surgeons less stark. They would all come down to a more of a middle ground. I think there's some truth to that. There still are standout robotic surgeons, but almost anybody can get adequate results for the patients and I didn't think that was true with the open surgery. There were a lot of arguments for many years regarding the results of the robot compared to open surgery, whether they are better or not. I still believe that in the hands of an expert, for example in radical prostatectomy, an open surgeon can get virtually the same results as a robotic surgeon, with the exception of blood loss, and that's an important one.
But it’s kind of a moot point, at least in the United States, because there are very few excellent open radical prostatectomy surgeons who even exist. There’s no one coming out of Urology residency in the last 10 years who has the skills that I think could permit them to challenge the results of robotic surgery. At least in countries where robots are widely available, it’s kind of a moot point. This ship has sailed!
F.N.: Given the rapid advancements in robotic surgery, what is your opinion on the current
role of traditional laparoscopy in the minimally- invasive treatment of urological malignancies? In 2025, does laparoscopy still hold a meaningful place in urological oncology?
Prof. Joseph A. Smith: If you don't have a robot, yes! There are some people with advanced laparoscopic skills that they can almost mimic the results of a robotic operation. I'm not one of them. If you took away my robot, my laparoscopic skills would be questionable. With a robot, you know, I'm pretty good. I've done a lot of them. I think that's true for many people. So, I think the true answer is that if you do not have access to a robot, then developing excellent laparoscopic skills is highly beneficial for our patients. But at least in our country, almost everybody has got access to a robot, and the robot definitely facilitates laparoscopic surgery and is used almost routinely. In Greece do almost all practitioners have access to a robot?
ΣΥΝΕΝΤΕΥΞΗ