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January 28, 2007

Robotic Surgery Growth: End of 2006

This is a monthly update on the growth of Robotic Surgery in my practice.

robotic_volume_12_06.jpg

I passed the 2 year anniversary of my first robotic operation this past month (Dec 13th).

There have been amazing things that have been done since then. I have been able to perform "perfect" nerve sparing radical prostatectomies in as little as 46 minutes of console time. I have also developed new operations in 2006 including removing bladders and parts of prostates for BPH.

The overall robotic volume increased from 79 operations in 2005 to 180 operations in 2006 (128 percent increase) and the volume of dvPs increased from 59 to 143 (142 percent increase).

I believe 2007 will see another large increase in robotic surgeries and robotic prostatectomies. I believe the growth will be spurred by 3 factors.

The first is obvious. I am performing better surgery in higher volume. This leads to a larger public awareness of robotics and has almost 300 of my patients educating their primary care physicians, friends, and family members.

The second is the purchase of a davinci units by new hospitals. I will be soon performing robotic surgery on the first daVinci S in Morris county, NJ, at St. Clare's hospital. I will likely be doing my operations with a friend of mine there.
Saint Barnabas hospital in Livingston will most likely soon purchase a robot as well. This has been my groups main hospital for many years now.
With this, I still plan on doing most of my robotic work at one of the nation's top robotic centers at Newark Beth Israel Medical Center.

The last reason is the successful recruitment of a urologist who is finishing his endourology fellowship at Thomas Jefferson, Dr. Brent Yanke. He will allow our group to offer 2 top robotic surgeons for years to come.

January 23, 2007

Article comparing surgery v. radiation v. watchful waiting

Key Highlights:
3,159 men studied
15 years long-term follow-up data
Primary data end point - Death, not PSA Recurrence
Weighted & Adjusted Outcomes in all Cohorts
Patients Treated with Radical Prostatectomy or Radiotherapy shown to live longer than patients in the Watchful Waiting Category
Overall Survival Rate is in favor of Radical Prostatectomy vs. Radiotherapy vs. Watchful Waiting (65%, 50%, 35% respectfully)
** The increased survival duration was 8.6 years for Radical Prostatectomy vs. 4.6 years for Radiotherapy (An 87% difference in favor of Radical Prostatectomy)

Tewari, Raman, Chang, Rao, Divine, Menon Urology 68 1268-1274, 2006

I haven't had a chance to read the article itself. The number of patients studied suggests the results are meaningful.

January 11, 2007

Radiation and hormonal therapy may lead to penile shortening.

Prostate cancer treatment may shorten penis - Yahoo! News

NEW YORK (Reuters Health) - Men who receive combination treatment with hormone therapy plus radiation for local or locally advanced prostate cancer may experience a significant reduction in penile length, according to a report in the January issue of the Journal of Urology
.

It has been long suspected that men may develop penile shortening after surgery, but this is the first report that I am aware of that it can also happen after radiation.

January 10, 2007

Men with sons may be less likely to have prostate cancer

ScienceDaily: Men With No Sons More At Risk For Prostate Cancer, According To New Study

"We surveyed vital status and cancer incidence, and found a strong trend for a decrease in prostate cancer risk as the number of sons increased," said Susan Harlap, MD, professor of clinical Epidemiology at the Mailman School of Public Health, and the leader of the research team. "We anticipate that this finding will have a significant impact on the direction of research in this field going forward." Overall, there was a 40% increase in prostate cancer in men lacking sons.

When I first read the headline, I thought this was some kind of statistical anomaly on a study. Reading the whole news article led me to understand that at least there is some science behind why this finding could happen, but I am not sure if this will hold up scientifically on further studies.

I wonder if someone has looked at the odds of a man having a son after having 1 or 2 daughters. If there is a problem on the Y chromosome as this study would suggest, then you would think that the likelihood of having a son after 1-2 daughters would be much less. I do not think this is the case.


Original blog I found this on: The Bayesian Heresy

January 7, 2007

Are da Vinci Pyeloplasties "Experimental"

I recently had an encounter with United Healthcare that initially resulted in a denial of a request to treat one of their patients with UPJ stenosis (partial obstruction of the drainage leading from the kidney to the bladder) with a robotic repair of the condition. The denial was initially based on the perception that such surgery was "experimental" and not a generally accepted form of treatment. After nearly two months of back and forth, I have approval to do the procedure and I believe I have convinced United Health to accept the procedure generally for all its subscribers. I have posted below several references to articles that I forwarded to the medical director in the course of our discussions. Most pyeloplasties are done in children and you can see that the articles reflect that, although my patient was an adult. Perhaps they will be of help to someone else in a similar situation.

Robotic Assisted Laparoscopic Pyeloplasty In Children, Atug F, Woods M, Burgess SV, Castle EP, Thomas R, The Journal of Urology, October 2005 (Vol. 174, Issue 4 (Part 1), Pages 1440-1442

Robot Assisted Pyeloplasty in the Infant—Lessons Learned, Kutikov A, Nguyen M, Guzzo T, Canter D, Casale P, The Journal of Urology, November 2006 (Vol. 176, Issue 5, Pages 2237-2240

Pediatric Robot Assisted Laparoscopic Dismembered Pyeloplasty, Comparison With a Cohort of Open Surgery, Lee RS, Retik AB, Borer JG, Peters C., The Journal of Urology, February 2006 (Vol. 175, Issue 2, Pages 683-687

Survey of Residency Training in Laparoscopic and Robotic Surgery, Duchene DA, Moinzadeh A, Gill IS, Clayman RV, Winfield HN, The Journal of Urology, November 2006 (Vol. 176, Issue 5, Pages 2158-2167)

Minimally Invasive Surgical Management of Ureteropelvic Junction Obstruction: Laparoscopic and Robot-Assisted Laparoscopic Pyeloplasty, Clayman RV, The Journal of Urology, March 2005 (Vol. 173, Issue 3, Page 868

January 6, 2007

Patients with diabetes may be at decreased risk of developing prostate cancer

UroToday - A Meta-Analysis of Diabetes Mellitus and the Risk of Prostate Cancer

A Meta-Analysis of Diabetes Mellitus and the Risk of Prostate Cancer
BERKELEY, CA (UroToday.com) - In 2004 a meta-analysis reported that patients with diabetes mellitus (DM) had a statistically significant decrease in risk (9%) of developing prostate cancer (CaP).
This has now been validated in a larger meta-analysis reported by Drs. Kasper and Giovannunucci from Harvard Medical School. Their report appears in the November 2006 issue of Cancer Epidemiology Biomarkers and Prevention.

Diabetes is a serious illness and patients who have diabetes should make every effort to control their sugar levels. This study may be important to researchers to help figure out how prostate cancer occurs and grows.