Participation at the Iberian meeting of Robotic Surgeons

This time I participated in the user meeting organized by Abex, the distributor for the Da Vinci system in Spain and Portugal, that took place at the "Casa de América" in Madrid.

My role was to speak about strategies to improve urinary continence after radical robotic prostatectomy.

I discussed the posterior reconstruction described by Rocco, the anterior and posterior reconstruction preconized by Tewari, the periurethral suspension of Patel, the ARVUS technique, the anterior reconstruction, MULP technique and bladder neck preservation.

Then I spoke about the preservation of the Retzius space, but then I centred myself in discussing the advantages of the right lateral approach of Dr Gaston, that in a certain way encompasses all these techniques by preserving the anterior support, allowing for the preservation of the bladder neck, preservation of urethral length, and has the advantage of allowing to perform an intra, inter or extrafascial dissection in each side and to decide if the neurovascular pubovesical complex of Santorini is preserved or not, depending on the location and aggressiveness of the tumour. 

I also presented our results at ICUA-Clinica CEMTRO, with excellent continence preservation with this technique. Dr Reinoso Elbers and Dr Rodriguez Socarrás from our team reviewed all our robotic experience of these last years and they carried out the statistical analysis of our data.

Continence preservation is optimal when the whole periprostatic tissue can be preserved, and a little worse when we have to be more aggressive to cure the tumour. The definition of continence or incontinence we used was the need to carry a pad or not.

I also showed that this technique, although technically difficult and demanding, is perfectly reproducible, as there are no statistical differences in the results obtained by Dr Gaston and myself in terms of urinary incontinence.

We published some videos in youtube of this technique performed by Dr. Gaston and myself. I include them here.

It is a great satisfaction to see how robotic surgery is becoming solid in spain for urologic surgery. The Da Vinci robot allows us to perform surgeries in a minimally invasive way and achieve results that are not possible with conventional laparoscopy or open surgery. An excellent initiative of Abex, to get us all in one room to discuss and share our experiences.