Does radiation therapy for prostate cancer lead to rectal cancer?
In contrast to a study from the University of Minnesota, there is a Canadian study that concludes that there is not a increased risk of rectal cancer when adjusted for age.
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July 22, 2006
Adrenal surgery: right vs left
I have performed several robotic adrenalectomies and about a dozen laparoscopic adrenalectomies. I have had excellent results with robotic and lap, and have not had any trouble with either the right of the left side.
I have several issues with this. I am fairly certain that the surgeons were experienced based on the results. Looking at retrospective data on this can lead to a false conclusion. The right side should be quicker since there is less tissue to mobilize, but often takes me the same time due to the extra care in isolating and controlling the right adrenal vein. I feel the right side are more difficult. I am still performing most of these laparoscopically because the endocrinologists that refer them only have privileges at a non-robotic hospital.
I especially like doing these robotically, as the robotic arms give you more flexibility with the enodwristed instruments.
Family history in prostate cancer
There is an article from physicians at the Cleveland clinic in the journal of clinical oncology:
Aggressiveness of Familial Prostate Cancer
The important points for men who have a family history of prostate cancer is that the 10 year biochemical relapse-free survival were worse for patients with a family history of prostate cancer before 1992, but since then were similar.
I think that awareness and screening has helped survival in patients that probably have more aggressive forms of prostate cancer.
Robotic Surgery Summary- June 06: focus: performing general surgery operations at the time of robotic prostatectomy
This is a monthly update on the growth of Robotic Surgery in my practice.
In June I performed 18 robotic operations. 17 were daVinci prostatetcomies for prostate cancer and 1 was a robotic nephro-ureterectomy. The total number of robotic prostatectomies is 129 and robotic operations is 165.
At the time of my robotic prostatectomies, my team also performed a robotic gallbladder removal in 1 patient and 3 robotic inguinal hernia repairs.
The highlights included our teams first robotic gallbladder removal at the time of dvP. We had to reposition the robot, but used the same draping for our patient. He did very well postoperatively.
We also performed 3 hernia repairs this month at the same time of dvP. One of the patients also had bladder stones that were removed at the same setting with the daVinci robot. All 3 were discharged home the day following surgery.
July 6, 2006
When having insurance doesn't pay: Robotic Prostate Surgery
When I first started this blog I tried to be fair about my views on different subjects, but also to be positive about them.
This is my first negative post and it has to do with the power of HMOs and their ability to prevent their patients from access to some technologies.
Patients every day ask me if their robotic prostatectomy for prostate cancer is covered by insurance and the answer is almost always yes.
Unfortunately this isn't the case throughout the country. A new patient of mine is flying across the country to have me perform his surgery. Half of the reason is because I am good at performing the surgery and have good results, but I am afraid to say the other half is because he can not have the surgery in California through his insurance plan.
Although there are many articles in the literature that support the use of robotics in urology, some insurance carriers still call it experimental and will not cover it.
The FDA approved robotic surgery with the daVinci robot for prostatectomy for prostate cancer in 2001.
My personal experience has consisted of over 200 open prostate cancer surgeries while in Indiana and New Jersey, as well as over 130 robotic prostatectomies in the last 17 months (my entire 9 man group has not performed an open one in the same time frame).
I can do the surgery well open or robotic, but feel the robotic is a far better procedure than open and will not perform an elective open prostatectomy for prostate cancer.
My reasoning as such:
With robotics, none of the 130 patients have been given blood and I haven't asked a patient to donate blood as we did with open since the 3rd operation.
The hospital stay has been cut to 24 hours for 93% of the patients, with only 1 patient in the last 100 going home after 2 days.
Most of my patients have resolution of their urinary function within 2 months and many are having erections in 2 months as well, which is much better than what I saw with open surgery.
To me this translates into a better operation.
It is unfortunate that patients that have insurance and think they are covered for all reasonable conditions are being denied in network coverage for their prostate cancer.
July 3, 2006
Rural parts of the US are purchasing daVinci robots: West Virginia
I believe this will be the 2nd robot in the state.