 دكتور جونلو ، شكرا لك for having the time and thank you so much for joining us in Qatar for the Qatar Robotic Surgery Center and first we'd like to know about you and your experience in Belgium so can you briefly tell us about it? Well, I'm a cardiac surgeon since a couple of years now we have started our robotic program since 2001 we have done almost like 750 cases mainly coronary surgery and so this is one of the reasons why I guess I was invited here to help people here to facilitate training center which is an amazing facility of course Okay, so tell us about the training you just gave today how did you find it? What were the comments of the participants and the objective of the training? Objectively I think this is a really appealing training because it was meant for cardiac surgeons experienced cardiac surgeons who had not that much the experience of the robot and the purpose of this training was to open their minds to any kind of cardiac robotic procedure and I think we have succeeded in that purpose because as you could see the whole morning people were fond of this device and tried anything possible on these two devices so I think it's a really great introduction to robotic cardiac surgery First training you hold in Qatar? This is the very first training actually for QRSC so it's a very first training although I was here with Dr. Abu Dhu Wahed to have this clinical experience since one year almost So in Belgium how often or how commonly use our robotics and surgeries in general and what's the reception there for robotics? So first you have to know that the robot is a really wonderful marketing tool and it's for sure so many people are coming at least in Belgium they are coming to the centers who have a robot to be operated by the robot This doesn't mean that they will be operated by the robot but it is an argument for them to come over and see if their case is a good robotic friendly procedure In Belgium we have 23 systems installed for 10 million inhabitants This is almost a world record as compared to the inhabitant number Unfortunately we only have one center ours who is dedicated to cardiac surgery all the others are meant to operate for urology digestive and gynecology surgery I say unfortunately because I wish that much more centers were using this robot in the cardiac surgery field and this is again working here and training all those cardiac surgeons is an opportunity to enhance the acceptance of such a device in cardiac surgery So in your presentation you discussed the shift from a 3 arm Da Vinci to the 4 arm one So why the shift and how was it an easy shift or did it take a lot of time So we had this back in 2001 we were one of the first centers who have used this robot in cardiac surgery it was really demanding it was a demanding operation it was an operation really we needed a very good teamwork to make this operation a success and the reason was that we had the very first generation of the robot with 3 arms and we needed a fourth one to stabilize the cardiac area where we wanted to suture let's say the memory we grabbed onto the heart because we did it on the beating heart from scratch then came the results from this experience were not very satisfactory the results were not that good as expected and this is probably why the acceptance nowadays seems not to be that big throughout the world since a couple of years since 2006 2007 a new generation arrived which is the DaVinci S system and obviously this was a tremendous improvement in the technical field because it had as you can see here just behind a fourth arm dedicated to the stabilization of the heart as far as coronary surgery concerns and this implied that this stabilization was controlled by the surgeon at the console so with this fourth arm he could navigate around the heart and stabilize dynamically I would say to have an optimal stabilization and this nowadays we know that this gave really a miraculous almost miraculous improvement in the feasibility and the safety of such a procedure and now we can easily start a training program because many things could be standardized thanks to this new generation so any new technology like robotics it usually has its own resistance from users who are not acquainted with it so from your experience what are the reasons that may cause the resistance to robotic surgery? of course the very first fear from the patients and from the cardiologist also as far as cardiac surgery concerns is the fact that we don't touch the patient it is almost a remote operation the surgeon being at say a couple of meters from the patient this is true and this is not quite true because of course you need a nurse a scrub nurse to handle the system you need an assistant that is a surgeon also at the patient side and that was a really fear meaning that if there was any failure of the system or if technically the procedure didn't go right sorry well there was a possibility that the patient could have major problems this is not true anymore because this system can be undocked really very very very easily and fast and in a couple of seconds we can go and convert into another non-robotic procedure so safety is now issue number one and this has been almost completely eradicated as a threat and this was the major threat that the cardiologist and the patients had at least in Belgium but I guess in the United States also there is another it's kind of the reverse situation meaning that many patients are coming like I said before coming to the hospital because this hospital has a robot so maybe that case will match with the robotic indication so some patients are a bit skeptical about whether robotics are as accurate as human surgeons so what would you tell them well that is not true of course actually you have a magnification of your operative field by a tenfold it is just like as if you were miniaturized as a very small surgeon into the throats and you see the vessels you see the heart as a huge anatomical complex so you are definitely more accurate simply by the vision a three dimensional vision you are much more accurate because you are not any more left handed or right handed you can play with our work with your right or your left hand without any problem and any side problem you can rotate your wrists three times 360 degrees which is not possible if you know how to handle the system you are definitely more accurate with it than a hand surgeon my final question you opened your presentation by asking a question is it worth investing in robotics so what is your answer for this yes because I was not talking about the financial aspect because this is an aspect that can be discussed I was talking about the energy that we could just give to this program of course it is worth trying this program if you have if you want to participate to a new project in surgery I mean I have started cardiac surgery almost 20 years ago and the the lead of my career was to bypass surgery until the rest of my life every day now 10 years ago robotics arrived and so you had to redefine everything I mean you have to rebuild another procedure to open doors that have never been opened before and this is a new challenge and so yes you definitely you have to invest in this kind of strategy Doctor Jean-Luc Kriansens thank you so much for this interview and we wish you the best of luck thanks a lot