21-23 MARCH,2002.

This ESUT affiliated Course took part on march 21-23,2002 in Bassano d/G,Italy ,under the chairmanship of Guglielmo Breda,member of the ESUT and Chief of the Division of Urology of Bassano’s Hospital,and Jean de la Rosette,Chairman of the ESUT.
It was a success,with more than 250 participants from all over the world,a great Faculty without any of the “last moment” deletions (on the contrary some three more Faculty Members were added ),and a perfect organization.
During a three really no stop,breathtaking days,10 major oncological laparoscopic operations were undertaken:The Surgeons were at work at 6.45 a.m.,the audio-visual link with the audience was opened at 7.15 and it was closed at 2 p.m.,when lectures and panel discussions started going on till 7 p.m.
The first day 4 renal tumors were operated: 3 RCC respectively 1,2,and 3 cm. in size were subjected to conservative surgery by Jens Rassweiler,Louis Kavoussi and Inderbir Gill. A 6 by 8 cm. angiomyolipoma underwent a Radical Nephrectomy by Ralph Clayman.
People were breathless in looking at the bright demonstration that,in the proper hands, open techniques of nephronsparing surgery can be duplicated laparoscopically.
No discussion about radical nephrectomy,which is already in large consensus,at least for T 1 Tumors,as it emerged in the afternoon Panel Discussion chaired by prof. .Pagano.The panel was a little bit more engaged in dealing with lymphadenectomy for testis cancer,where Guenther Janetschek presented his huge serie of more than 160 cases done with no complications:there was a very participated discussion with the audience which had exhausted any seat of the nice Auditorium in the bottom of the modern Hospital of Bassano.
Ralph Clayman presented a very nice lecture on “Economics” of laparoscopic nephrectomy,showing the american paradoxe of paying less for a laparoscopic ( $ 1200) than for an open ($ 1600 ).The rational? Less pain,less drugs, less days in the Hospital=less global care !
The day after, three radical prostatectomies were done by Jens Rassweiler,Ingor Tuerk with Stefan Loening and Inderbir Gill.Dr.Tuerk’ case was particularly interesting because they did also a sural nerve graft.In their experience at Charité Hospital in Berlin 16 previous cases had already been made,they said.But results are still pending,because it takes about 18 months in order to achieve a full nerve regeneration.
The main controversies in the afternoon discussions,chaired by prof. Artibani,were about laparoscopic radical prostatectomy,where the recurrent question is : is it better? Obviously there were partizans from both party and Jean de la Rosette contributed to put fuel on the fire starting the afternoon with a slide entitled :” A nice show or a real need?”.Louis Kavoussi outlined that the only real advantage of laparoscopy that had already been demonstrated was a less blood loss,but at a cost of a very hard learning curve ( at least 50-80 cases ),which potentially means 400.000 patients “sacrificed” ,should all the american urologists operating prostate cancer start to do it laparoscopically !Jens Rassweiler,Ingor Tuerk ,Inderbir Gill,Vito Pansadoro,Vincenzo Disanto ( who presented the Italian experience)andGiorgio Guazzoni were all in favour,outlining mainly the fact that the good visibility allows a very good anatomical dissection with potentially better functional results.As a matter of fact today we cannot overlook that the follow-up is still too short in order to draw some firm conclusion and,more importantly,comparative prospective randomized studies are needed.The take home message was : do it if you are able to do it,but be prudent,speak to your patient and explain to him the real things he wants to know and dont let the media speak about the miracles of laparoscopic radical prostatectomy !
The third day was fully devoted to live surgery.Guenther Janetschek operated on two consecutive cases of right and left testicular cancer (NSGCT),performing right and left retroperitoneal lymphadenectomy in a very convincing way.Everyone had to admit that,done like that, it’s better than the open counterpart: the only problem is to do it like that !!! Inderbir Gill operated on a 51 y. old woman with a bladder cancer.He did a radical cystectomy with an extended bilateral lymphadenectomy and a Studer neo-bladder completely intracorporelly in 10 hours,showing that it can be performed by pure laparoscopic technique..However,we are still in the initial experience and the few cases until now done merely demostrates technical feasibility.Considerable additional work is necessary to critically compare outcomes with open surgery so as to determine the true place of laparoscopic techniques.
In conclusion,this was an excellent course which had the merit of opening the doors of urological oncology to laparoscopy.As Giampaolo Bianchi,President of the Italian Endourology Society, outlined in his brilliant State of the Art Lecture at the opening of the Course,the fear of portal seeding in urological laparoscopic surgery is only a fear and this was one of the main obstacles to the expansion of laparoscopy in the domain of oncology.This Course definitively demonstrated that all oncological procedures are feasible,provided you have adequate training.The problem now will be to provide adequate training for all the Urologists willing to expand their surgical armamentarium to laparoscopy.This is one of main the reasons why the European Society of Uro-Technology exists and is so active in this field!