Chit Sin Loh

Dr Loh Chit Sin is a leading urologist with 40+ years’ experience, specializing in robotic & minimally invasive surgery and uro-oncology. He has served as President of the Malaysian Urological Association and Chairman of Minimally Invasive Surgery Chapter of The College of Surgeons Malaysia. He has performed about 1,500 cases of robotic operations and has many publications mainly in oncology.

15th August 2025

Time Session
15:30
17:00
Semi-Live Surgery 2
  • Robotic Partial Nephrectomy in Complex and Difficult Tumor Location
    Hideki EnokidaJapan Moderator
    Siros JitpraphaiThailand Speaker RCC and IVC ThrombectomyRCC and IVC thrombus Siros Jitpraphai Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND Abstract Renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus represents a complex surgical challenge, with an incidence of venous involvement in 4-10% of cases. This case report demonstrates the successful surgical management of a 58-year-old female patient with a large left-sided renal mass and IVC thrombus. The patient presented with gross hematuria and was diagnosed with a 10 cm clear cell renal cell carcinoma (Fuhrman nuclear grade 3) extending into the renal vein and IVC. Recognizing the complexity of the case, a multidisciplinary approach was employed, involving urological and hepatobiliary surgical teams. The comprehensive treatment strategy included an open radical nephrectomy with IVC thrombectomy. The surgical technique was meticulously planned and executed, with several key considerations. Preoperative imaging was crucial in determining the exact level of thrombus, allowing for precise surgical planning. The procedure emphasized careful vascular control and en-bloc tumor removal, with intraoperative ultrasound used to ensure accurate thrombus localization. Surgical teams worked collaboratively to minimize potential complications and maximize surgical success. Operatively, the procedure was substantial, with an estimated blood loss of 900 mL and a total operative time of 5 hours. The patient required two days of postoperative intensive care and was discharged from the hospital seven days after the surgery. Pathological examination confirmed the diagnosis of clear cell renal cell carcinoma, with no lymph node metastasis detected and positive tumor thrombus. Importantly, surgical margins were found to be free of tumor. Follow-up evaluations have been encouraging, with no signs of tumor recurrence observed during regular intervals. This case illustrates the critical importance of a systematic surgical approach, precise technical execution, and comprehensive multidisciplinary management in successfully treating RCC with IVC thrombus. It provides valuable insights into the complex surgical management of this challenging condition, potentially offering guidance for similar cases in the future. Keyword: RCC (Renal Cell Carcinoma), IVC Thrombus, Thrombectomy, Surgical Technique, Multidisciplinary Management Highlight: RCC with IVC thrombus is a complex surgical challenge affecting 4-10% of cases. Successful management requires meticulous preoperative imaging, multidisciplinary team approach, and precise surgical technique. With careful planning and execution, 45-70% of patients can be cured through radical nephrectomy and IVC thrombectomy. Robotic Partial Nephrectomy in Complex and Difficult Tumor Location
  • Robotic Partial Nephrectomy in Tumors with High Renal Score
    Katsumi ShigemuraJapan Moderator
    Surya Prakash VaddiIndia Speaker Cytoreductive Nephrectomy in the Era of Immune TherapyRobotic Partial Nephrectomy in Tumors with High Renal Score
  • Zero Ischemia Laparoscopic Partial Nephrectomy
    John YuenSingapore Moderator Technical Pearls: Total Extraperitoneal TechniquePractice-Changing Development in RaLRP
    Andrew Kennedy SmithNew Zealand Speaker Zero Ischemia Laparoscopic Partial NephrectomyNephron preservation with complete tumour excision and without complications remain the goals of surgery for early-stage kidney tumours. This surgery remains technically challenging using a minimally invasive platform, and there remain variations of technique. We present what is now an established approach within our centre, but has been enhanced by progressive improvements in the specific surgical instrumentation. The technique is achievable in a smaller centre with lower surgical volumes. We perform a laparoscopic partial nephrectomy using waterjet and advanced bipolar energy without vascular clamping and without renorrhaphy, supplemented with topical hemostatic agents, reliably achieving the stated goals of this surgery. Ischaemia and delayed complications are minimised by avoiding renorrhaphy and vascular clamping during dissection.Zero Ischemia Laparoscopic Partial Nephrectomy for Hilar TumorsOur technique for hilar tumours remains similar to that for peripheral tumours, again using waterjet and advanced bipolar energy without vascular clamping and without renorrhaphy, supplemented with topical hemostatic agents. Waterjet may be safely used directly on major vessels and collecting system structures, and directly on the tumour capsule, to perform either conventional partial nephrectomy with parenchymal margin or tumour enucleation. With hilar dissection, it is possible to visualise and control arterial supply directly to the tumour, reducing the potential for blood loss. The stated goals of this surgery are achieved. The technique which avoids renorrhaphy is particularly relevant in hilar tumours where renorrhaphy may not be technically achievable.
  • Zero Ischemia Laparoscopic Partial Nephrectomy for Hilar Tumors
    Takashi SaikaJapan Moderator
    Andrew Kennedy SmithNew Zealand Speaker Zero Ischemia Laparoscopic Partial NephrectomyNephron preservation with complete tumour excision and without complications remain the goals of surgery for early-stage kidney tumours. This surgery remains technically challenging using a minimally invasive platform, and there remain variations of technique. We present what is now an established approach within our centre, but has been enhanced by progressive improvements in the specific surgical instrumentation. The technique is achievable in a smaller centre with lower surgical volumes. We perform a laparoscopic partial nephrectomy using waterjet and advanced bipolar energy without vascular clamping and without renorrhaphy, supplemented with topical hemostatic agents, reliably achieving the stated goals of this surgery. Ischaemia and delayed complications are minimised by avoiding renorrhaphy and vascular clamping during dissection.Zero Ischemia Laparoscopic Partial Nephrectomy for Hilar TumorsOur technique for hilar tumours remains similar to that for peripheral tumours, again using waterjet and advanced bipolar energy without vascular clamping and without renorrhaphy, supplemented with topical hemostatic agents. Waterjet may be safely used directly on major vessels and collecting system structures, and directly on the tumour capsule, to perform either conventional partial nephrectomy with parenchymal margin or tumour enucleation. With hilar dissection, it is possible to visualise and control arterial supply directly to the tumour, reducing the potential for blood loss. The stated goals of this surgery are achieved. The technique which avoids renorrhaphy is particularly relevant in hilar tumours where renorrhaphy may not be technically achievable.
  • Robot-Assisted Radical Cystectomy and Intracorporeal Neobladder Formation
    Steven K. HuangTaiwan Moderator
    Arnulf StenzlGermany Speaker EAU Lecture: AI to Support Informed Decision Making (INSIDE) for Improved Literature Analysis in Oncology.Robot-Assisted Radical Cystectomy and Intracorporeal Neobladder Formation
  • Technical Modifications Facilitate Robotic-Assisted Nephroureterectomy and Bladder Cuff Resection
    Chit Sin LohMalaysia Moderator
    Jeff S. ChuehTaiwan Speaker
TICC - 3F Plenary Hall

16th August 2025

Time Session
15:30
17:00
Semi-Live Surgery 4
  • Robotic Prostatectomy Using da Vinci SP System
    Victor C. LinTaiwan Moderator
    Chit Sin LohMalaysia Moderator
    Rajeev TPIndia Moderator Newer Advances in the Endourological Management of Stones – Have We Reached the Zenith
    Po-Hung LinTaiwan Speaker Robotic Prostatectomy Using da Vinci SP SystemIn this semi-live section I will demonstrate the steps of extraperitoneal-approach radical prostatectomy using DAVINCI SP system.How to Make the Best Decision with Systemic Therapy Sequence in Respective of Genetic AnalysisRenal cell carcinoma (RCC) is a biologically heterogeneous disease driven by a limited set of convergent pathways that together shape oncogenesis, immune evasion, and therapeutic response. Across clear-cell RCC (ccRCC), recurrent alterations include VHL, PBRM1, BAP1, and SETD2, mapping onto five dominant axes: hypoxia signaling (VHL–HIF), PI3K/AKT/mTOR, chromatin remodeling, cell-cycle control, and metabolic rewiring. These lesions variably interact—e.g., mTORC1 enhances HIF translation—creating therapeutic opportunities (VEGF tyrosine-kinase inhibitors, HIF-2α inhibition, mTOR blockade) and constraints (adaptive resistance via metabolic plasticity). While immune checkpoint inhibitors (ICIs) and ICI–TKI combinations have improved outcomes in metastatic RCC, robust predictive biomarkers remain elusive. Tumor mutational burden is typically low and noninformative; PD-L1 shows assay- and context-dependent utility; PBRM1 and BAP1 are more prognostic than predictive. Emerging signals include angiogenic versus T-effector/myeloid transcriptional signatures, sarcomatoid/rhabdoid histology as a surrogate of immune-inflamed state, and host factors such as HLA genotype and gut microbiome composition. Liquid-biopsy modalities (ctDNA and methylome profiling) and spatial/single-cell atlases reveal intratumoral heterogeneity, T-cell exclusion niches, and myeloid programs (e.g., TREM2⁺ macrophages) linked to recurrence or ICI benefit. Early data support metabolism-targeted strategies (e.g., glutaminase inhibition) and rational combinations co-targeting angiogenesis, hypoxia signaling, and immune checkpoints; however, toxicity management and resistance evolution require prospective, biomarker-integrated trials. A clinical schema that pairs baseline multi-omic and microenvironmental profiling with adaptive surveillance (serial liquid biopsies, functional imaging) can lead to dynamically select among ICI–ICI, ICI–TKI, targeted, and experimental regimens. Robotic Prostatectomy Using da Vinci SP System
  • Extravasculare Renal Denervation to Treat Resistant Hypertension
    Victor C. LinTaiwan Moderator
    Chit Sin LohMalaysia Moderator
    Rajeev TPIndia Moderator Newer Advances in the Endourological Management of Stones – Have We Reached the Zenith
    Chang Wook JeongKorea (Republic of) Speaker Extravasculare Renal Denervation to Treat Resistant HypertensionResistant hypertension is defined as uncontrolled blood pressure above the target, despite the concurrent use of three or more antihypertensive medications. Individuals with resistant hypertension are at a high risk for severe cardiovascular events and mortality. Managing resistant hypertension is challenging, and many non-pharmacological treatments, including renal denervation (RDN), have been introduced. This presentation will demonstrate the surgical technique of the extravascular RDN (eRDN) using the HyperQure™ System performed as part of the first-in-human trial. The surgeries were performed as a retroperitoneal approach in a modified prone position. The preliminary results will be presented, too. In the United States, a prospective, multicenter, early feasibility study is also underway.
  • Game Changer or Gimmick? Evaluating the shift to Retzius Sparing
    Victor C. LinTaiwan Moderator
    Chit Sin LohMalaysia Moderator
    Rajeev TPIndia Moderator Newer Advances in the Endourological Management of Stones – Have We Reached the Zenith
    Aaron GohMalaysia Speaker Game Changer or Gimmick? Evaluating the shift to Retzius SparingRetzius-sparing radical prostatectomy (RS-RP) offers a significant functional advantage, particularly in terms of immediate continence recovery. Despite early skepticism, non-inferior oncological outcomes have been observed in our personal case series, supporting its wider adoption. However, many surgeons still perceive the transition from the conventional anterior approach as technically challenging. A practical way to bridge this gap is through the hood-sparing technique, which modifies the anterior approach to preserve anterior support structures while gradually introducing the anterior dissection plane in a more familiar sequence. One critical but often overlooked determinant of success is the role of the bedside assistant. In academic centres, assistants are usually well-trained fellows; in many other settings, assistance is limited to rotational nurses or junior trainees. A clipless RS-RP technique simplifies the assistant’s role, requiring mainly suctioning and instrument passage. Concerns regarding nerve injury can be addressed using pinpoint monopolar or low-power bipolar energy, which allows for precise dissection with minimal lateral thermal spread. This session will demonstrate the RS-RP technique in a semi-live format, highlighting steps to safely adopt it outside high-volume centres. With structured modifications and thoughtful case selection, the shift to RS-RP can be both practical and beneficial.
  • Transperineal Fusion Biopsy of Prostate: Tips and Tricks
    Victor C. LinTaiwan Moderator
    Chit Sin LohMalaysia Moderator
    Rajeev TPIndia Moderator Newer Advances in the Endourological Management of Stones – Have We Reached the Zenith
    Guan Hee TanMalaysia Speaker Transperineal Fusion Biopsy of Prostate: Tips and TricksTransperineal MRI-ultrasound fusion biopsy has emerged as a highly accurate and safe approach for prostate cancer diagnosis. The transperineal approach to prostate biopsy offers high precision in diagnosing clinically-significant prostate cancer while minimizing infection risks. This semi-live video presentation demonstrates a step-by-step approach to the procedure using the Koelis platform, focusing on optimal setup, image registration, and targeted sampling techniques. Key aspects include patient positioning, probe fixation, and system calibration to ensure accurate fusion of pre-procedural MRI with real-time ultrasound. I will highlight strategies for efficient lesion targeting, including trajectory planning, and needle deployment when performing this procedure. This video aims to provide viewers with a clear, practical guide to performing transperineal fusion biopsy on the Koelis system, enhancing diagnostic accuracy and procedural efficiency.
  • Robotic Partial Nephrectomy: Beyond Technique
    Victor C. LinTaiwan Moderator
    Chit Sin LohMalaysia Moderator
    Rajeev TPIndia Moderator Newer Advances in the Endourological Management of Stones – Have We Reached the Zenith
    Henry HoSingapore Speaker Technical Pearls: Wheel-Barrow TechniquesBringing Innovation to PatientRobotic Partial Nephrectomy: Beyond Technique
  • Nephro-Ureterectomy with Cystectomy & Other Uncommon Uro-Oncology Cases
    Victor C. LinTaiwan Moderator
    Chit Sin LohMalaysia Moderator
    Rajeev TPIndia Moderator Newer Advances in the Endourological Management of Stones – Have We Reached the Zenith
    Lih-Ming WongAustralia Speaker Nephro-Ureterectomy with Cystectomy & Other Uncommon Uro-Oncology CasesTo generate discussion and interest, a selection of uncommon tumours excised robotically will be presented. These will be chosen from a selection of prostate sarcoma, pelvic liposarcoma, retroperitoneal schwannoma, distal ureterectomy and urachal adenocarcinoma.
  • Discussion
TICC - 3F Plenary Hall