Innovations in stone surgery, live from the congress floor

23 January 2020

edited cover photo

The 7th meeting of the EAU Section of Uro-Technology got off to a good start in Leipzig this morning, with a packed auditorium for the trademark live surgery sessions.

The meeting boasts over 500 delegates in attendance, and together with faculty and exhibitors, this means more than 700 expected uro-technology experts in the Kongresshalle am Zoo on 23 and 24 January. Attendance figures were undoubtedly boosted by members of the German Working Groups of Endourology, Laparoscopy and Robotic Assisted Surgery, as ESUT20 is organized in conjunction with these DGU bodies.

ESUT Chairman Prof. Evangelos Liatsikos and ESUT20 Chairman Prof. Jens-Uwe Stolzenburg opened the proceedings on Thursday morning, welcoming the assembled delegates. Prof. Stolzenburg then dashed off, as he was expected to perform a robotic partial nephrectomy just an hour later.

The opening presentation fell to Prof. Oliver Hakenberg, who reflected on the strength and speed of developments in urological surgery over just the past twenty years. Even within robotic surgery, developments have redesigned operating theatres and indeed the teams themselves. “Where will these advances take us? This meeting will give us excellent input and an opportunity for learning,” Hakenberg concluded.

Innovations in stone surgery

Learning was certainly on the cards in the first set of simultaneous live sessions. Prof. Olivier Traxer gave what amounted to a masterclass on current techniques in flexible ureteroscopic lithotripsy.

Traxer gave practical tips throughout his operation: which instruments he prefers, how he arrives at decisions together with his patients, machine settings and finally personal surgery technique. Prof. Traxer demonstrated his dusting technique, working slowly but surely around the outside of the monohydrate stone, eventually saving time by hopefully avoiding basketting. Unfortunately, due to some fragmentation, basketting was unavoidable in this particular case.

Prof. Traxer was asked what his advice would be for beginning stone surgeons: “I would advise those starting a practice for stone surgery to not be too optimistic and start by treating small stones, one centimeter or smaller. I would advise pre-stenting for beginners to facilitate the procedure. Finally, you shouldn’t be working in sessions longer than one hour at a time.”

Asked on the advantages and disadvantages of single-use endoscopes, Prof. Traxer saw a bright future for single-use, with some caveats. “I think single-use will become standard in the coming years. The scope is completely sterile, always available, and you always have the latest model. The only disadvantage is that they are still on the large side. We still need reusable fibre optic systems for small access. So be careful in shifting to only digital single-use systems, or you won’t be able to perform small cases. The companies making digital scopes have to make small ones that are as good as the current fibre-optic systems.”

Taste the stone

As Traxer finished up, the session on Screen 1 (of 3) continued with a similar case by Dr. Oliver Wiseman. Dr. Wiseman was demonstrating the LithoVue in combination with an EMPOWER attachment to let the surgeon control the basket. He also demonstrated the SAPS on-demand irrigation system and emphasised the importance of minimizing X-ray use for the surgeon and the patient.

Dr. Wiseman explained proper use of access sheaths and their advantages for the surgeon and patient. He encouraged other surgeons to first “taste the stone” and always adjust the procedure based on the consistency of the individual stone.