| Robotic Surgery Blog
Source Urotoday
The trial planned to enroll 200 patients, but an interim analysis at 107 patients met criteria for futility and the trial was closed. For patients completing the protocol to 2 yr, potency was recovered in 32 of 45 (71%) of SNG and 14 of 21 (67%) of controls (p=0.777). By intent-to-treat analysis, potency recovered in 32 of 66 (48.5%) of SNG and 14 of 41 (34%) of controls (p=0.271). No differences were seen in time to potency or quality of life scores for ED and urinary function. Limitations included slower-than-expected accrual and poor compliance with ED therapy: < 65% for VED and < 40% for injections.
The addition of SNG to a UNS RP did not improve potency at 2 yr following surgery.
This study was comparing men who were going nerve sparing prostatectomy on one side and adding a nerve graft on the other side. Nerve grafting takes more time and has some side effects depending on which nerve you use. This study, like many before it, did not find a benefit in performing a nerve graft.
I've always felt that this wwould be the case since the neurovascualr bundle is a series of small microscopic nerves, not a large nerve that you can see.
Source: Tara Parker-Pope - Health - New York Times Blog
One in five men who undergoes prostate surgery to treat cancer later regrets the decision, a new study shows. And surprisingly, regret is highest among men who opt for robotic prostatectomy, a minimally invasive surgery that is growing in popularity as a treatment.
The research, published in the medical journal European Urology, is the latest to suggest that technological advances in prostate surgery haven't necessarily translated to better results for the men on which it is performed. It also adds to growing concerns that men are being misled about the real risks and benefits of robotic surgical procedures used to treat prostate cancer.
This was an interesting article about prostate cancer satisfaction rates. The important point was that patients who underwent robotic prostatectomy were not as satisfied as patients that underwent conventionally surgery. It is interesting to read the comments as well.
The important things that I have done that I believe give me a higher satisfaction rate is to better explain how the procedure is still a major surgery. I know that my patients expect less problems and I believe they do have less problems. The important thing is to have them understand it is still a major surgery that is similar to open surgery in what we are trying to accomplish.
That being said, once expectations are realistic, most patienst are satisfied. I do notice that the satisfaction rate is often higher in patients that have worse than expected incontinence. After several weeks to months, once the urinary control is back to normal people have a much higher satisfaction rate.
Source: Washington University Website
"Robotic surgery is more efficient and precise than either open or laparoscopic surgery for tumors confined to the kidney," says Bhayani, assistant professor of surgery and a leader in the field of robotic surgery. "Rather than operate with two hands, I can simultaneously control four robotic instruments with mechanical "wrists" that rotate more than 360 degrees, giving me far greater maneuverability than human hands or laparoscopic instruments." Bhayani led a team at Washington University to develop the procedure for kidney tumors.
Dr Bhayani is a friend and excellent surgeon. Check out his website for a video clip of the partial nephrectomy. I was recently invited as a guest faculty at his conference (First Annual World Robotic Renal Symposium) and had the privilege of watching him perform 2 live surgeries, a robotic nephrectomy and a robotic partial nephrectomy. Both went very well.
Source: UPI
Men who work at desk jobs are more likely to develop prostate cancer than manual workers, a study indicates.
Researchers found low levels of physical activity in the workplace can significantly raise the risk of cancer, the Daily Mail reported Saturday.
The study determined men who worked as teachers or in office jobs were much more likely to get cancer than those who spend much of their day on their feet, such as laborers, bakers and barbers.
Specifically, men who spend their day working at a desk are 30 percent more likely to develop prostate cancer than manual workers, the study found.
This study shows that men with sedentery jobs are at increased risk or prostate cancer. I wouldn't advise changing careers, but adding exercise to your daily regimen should help prevent illnesses and probably helps prevent recurrences and delays progression in men who have cancer.
Source: UroToday
Robotic cystectomy was performed in 40 men and 10 women at a mean age of 63.6 years. Of the 50 patients, 66% had Stage pT2 or less, 14% had pT3 disease, and 20% Stage N+ disease. No patient had positive surgical margins.
This abstract is from one of the leading centers for robotic cystectomy. They show relatively low morbidity for a major surgery. I have done about 20 cystectomies robotically and have switched almost all of my major bladder cancer surgery to this approach. I think I am performing the same oncological operation as open, but have seen less blood less and quicker recoveries.
From UroToday:
We examined the association between percent tumor involvement in the radical prostatectomy specimen and the outcome measures of pathological stage and biochemical progression using multivariate logistic regression and Cox proportional hazards analysis, respectively, in 2,220 patients from the Duke Prostate Center radical prostatectomy database.
This was a study that showed that if you had more cancer in the prostarte, you had a higher risk of teh cancer coming back after surgery. Although this is obvious, it is important to show these type of things with studies.
Would I would like to see is if patients with the same gleason score and stage (meaning the extent of cancer spread) have different rates of recurrences.
For example, 2 men with organ confined prostate cancer that both have gleason 6 cancers. If 1 man has 1% of tumor volume in his prostate and the other 30%, I would imagine the man with 30% would be more likely to have a recurrence. I am not aware of any studies that have looked at this.
From Urotoday and the AUA
Of the 2134 PCa cases, 169 (7.9%) had AS as their initial management. Of the 169 AS cases, 89 (53%) remained untreated throughout follow-up (mean 7.1 years) and the remaining 47% received treatment an average of 3.1 years post-diagnosis. Significant predictors of eventual active treatment in multivariate models included younger age at diagnosis (60-69 vs. 70+ years), higher Gleason score (>6 vs. <6), and higher prostate cancer aggressiveness/risk. The researchers observed similar rates for development of clinical metastases and PCa death in both AS and immediate treatment groups, respectively (metastases: N=8 and N=92, 6.5 vs. 6.7 events per 1,000 person-years, p=1.0; PCa death: N=4 and N=51, 2.4 vs. 2.7 deaths per 1,000 person-yrs, p=1.0).
This one study shows that men that did active surveillance, needed therapy about half of the time. The results seemed similar for both groups. My main concern is that we do not know the cancer characteristics of the patients. It is possible that the active surveillance patients had less cancer than the treated patients and should have done better.
I also think that waiting 3 years to treat someone may later the treatment approach and possibly lead to more side effects after therapy.
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