(UroToday.com) In his engaging and insightful presentation, Dr. Richard Link, humorously referring to himself as a "reinvented transperitoneal curmudgeon," took the audience on a journey through the evolution of surgical techniques in urology, emphasizing the importance of adaptability and innovation in the field.
Dr. Link, who began his career during the transition from open surgeries to transperitoneal laparoscopic and robotic surgeries in the late 1990s to early 2000s, highlighted how these advancements significantly improved patient care.
Over the following decade, technological advancements led to increasingly complex procedures, though many surgeons remained committed to transperitoneal approaches.
However, pioneers like Drs. Indirbir Gill and James Porter challenged the status quo, advocating for alternative methods. A significant portion of the session focused on the benefits of regionalizing kidney surgeries. Dr. Link underscored this, noting that this approach offers numerous advantages, including reduced patient pain, faster recovery times, and minimized risk of injury to intra-abdominal organs.
He discussed the merits of both transperitoneal and retroperitoneal access in partial nephrectomies. Transperitoneal access provides a large working space and familiar anatomy, while retroperitoneal access, although challenging due to its smaller working space and unfamiliar anatomy, offers faster operative times and quicker recovery for patients.
The introduction of the da Vinci Xi in 2014, optimized for retroperitoneal flank access initially struggled to gain widespread adoption due to its awkward application in certain procedures.
However, the release of the da Vinci SP in 2018 marked a significant advancement, particularly in regionalization for retroperitoneal surgery, allowing for more precise and less invasive procedures.
Dr. Link highlighted Dr. Simone Crivellaro’s novel Supine Anterior Retroperitoneal Access via robotic single-port surgery from 2023, for its ability to provide equal access to all aspects of the kidney, regardless of tumor location.
He showcased how this approach, along with the SP robot system, has significantly improved surgical outcomes in his surgical practice on many fronts.
In the past 24 months, he has utilized both retroperitoneal and transperitoneal access techniques which have led to a higher percentage of patients being discharged within a day of surgery.
To conclude his talk, Dr. Link emphasized the importance of selecting the appropriate surgical approach based on tumor characteristics, patient history, and surgeon experience. While the SP system offers considerable advantages, he advised surgeons to carefully consider each case's specifics. He encouraged surgeons new to low anterior retroperitoneal partial nephrectomies to begin with less complex cases, gradually progressing to more challenging surgeries, with the ultimate goal of minimizing patient morbidity and maximizing operative efficiency.
Dr. Link's presentation underscored the importance of continuous learning and adaptation, reinforcing the critical role of innovation in advancing patient care in urology.
Presented by: Richard E. Link, MD, PhD, Baylor College of Medicine, Houston, TX
Moderated by: Ravi Munver, MD, FACS, Hackensack Meridian Health, Hackensack, NJ
Panelists: Riccardo Autorino, MD, PhD; Monica S. Morgan, MD; Jinsung Park, MD, PhD; Silvia Secco, MD FEBU; Chandru P. Sundaram, MD, MBA, FRCS
Written By: Seyed Amiryaghoub M. Lavasani, B.A., University of California, Irvine, @amirlavasani_ on Twitter during the 2024 World Congress of Endourology and Uro-Technology (WCET) Annual Meeting, August 12 -16, 2024, Seoul, South Korea