Running a hospital blog entry: da Vinci Uncoded -- or, Surgical Robots Unite!
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Here you have it folks -- the problem facing every hospital, and
especially every academic medical center. Do I spend over $1 million on
a machine that has no proven incremental value for patients, so that our
doctors can become adept at using it and stay up-to-date with the "state
of the art", so that I can then spend more money marketing it, and so
that I can protect profitable market share against similar moves by my
competitors?
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This entry caught my attention since it discussed robotic surgery.
It is from the blog of the CEO at Beth Israel Deaconess Medical Center in Boston. He seems to have put together an excellent blog and I look forward to following his decision to purchase or not purchase the robot.
The Nation: Surgical success story
| Siriraj Hospital yesterday successfully carried out Thailand's first prostate operation using a revolutionary robotic surgery system, which claims to reduce trauma and side-effects. |
The growth in robotic sales outside the US seems to be growing.
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At completion of the study, 1mg/day finasteride resulted in a median serum PSA decrease of 40% (95% CI 34 to 46) in men ages 40-49 years (mean PSA 0.8 ng/ml) and 50% in men ages 50 to 60 years (mean PSA 1.1 ng/ml). These were statistically significantly different from decreases in PSA in men taking placebo for both age groups [0% (mean PSA 1.0 ng/ml) and +13% (mean PSA 1.2 ng/ml) respectively]. |
It was felt that even low doses of finasteride may lower PSA. According to this well done study it appears that the PSA is lowered by 40-50%.
Patients should make sure they tell their physicians if they are taking medicines to prevent hair loss.
There are other studies that show that this medicine in higher doses may lower the risk of developing prostate cancer, but a higher percentage of cancers were high grade. It would be a good idea to discuss your use of this medicine with your PMD or urologist.
Body Mass Index, Weight Change, and Risk of Prostate Cancer in the Cancer Prevention Study II Nutrition Cohort
Written by Ricardo Sanchez-Ortiz, MD
Thursday, 15 February 2007
BERKELEY, CA (UroToday.com) - In the last five years, a large body of evidence has been accumulated supporting the association between obesity and high-risk prostate cancer.
Despite this advancement in our knowledge of prostate carcinogenesis, the exact interplay between BMI and patient risk remains poorly understood.
In the January issue of Cancer Epidemiology, Biomarkers, RodrÃguez and colleagues from the American Cancer Society report data from the Cancer Prevention Study II Nutrition Cohort evaluating the relationship between obesity and prostate cancer risk. Beside its large size, this study is newsworthy because it substratified prostate cancer patients based on tumor grade and stage.
The cohort consisted of 69,991 men who registered information on height and weight at enrollment (year 1982) and were followed for 20 years. Patients with an elevated BMI exhibited a lower risk for non-metastatic low grade prostate cancer (risk ratio: 0.84), but demonstrated a higher trend for being diagnosed with nonmetasteatic high grade prostate cancer (risk ratio: 1.22, 95% CI 0.96 to 1.55) and a higher risk for dying of metastatic prostate cancer (risk ratio: 1.54, 95% CI 1.06 to 2.23). Interestingly, those men with a registered weight loss of greater than 11 pounds (in the first 10 years of the study) were found to have a significantly decreased risk of developing nonmetastatic high-grade prostate cancer (RR: 0.58, 95% CI 0.42 to 0.79).
These data from a large, prospective, epidemiological study suggest that patients with an elevated BMI are less likely to develop low grade prostate cancer and more likely to develop high grade prostate cancer. This dichotomous distribution in risk may partly explain why studies that have not substratified patients based on tumor grade had not found an association between obesity and prostate risk. Furthermore, perhaps the most compelling argument in favor of this increased risk was the documented risk reduction in high grade prostate cancer with dietary modification and weight loss.
Carmen Rodriguez, Stephen J. Freedland, Anusila Deka, Eric J. Jacobs, Marjorie L. McCullough, Alpa V. Patel, Michael J. Thun, and Eugenia E. Calle
Cancer Epidemiol Biomarkers Prev.;16(1):63-9.
UroToday.com Prostate Cancer Section
This is the monthly update of my robotic surgery practice at Newark Beth Israel Medical Center. This months focus is on prostate cancer, with a record 24 dvPS performed this month.
This month I performed 27 robotic surgeries including 24 da Vinci prostatectomies for prostate cancer. Both of these are a record for 1 month in my practice and I had several important firsts.
I performed my first combo major robotic operation on a gentleman who was found to have a UPJ obstruction when he had a metastatic evaluation for prostate cancer. I performed a dvP and a robotic pyeloplasty at the same setting using the same 6 ports I would use for a dvP. The most amazing part of the operation is that each operation took less than an hour (the dvP was a record 46 minutes) and the patient still went home the following day.
I performed my first few dvPs in under 1 hour. Although time is not an important factor, these cases were still done very carefully. My feeling that these cases could not be done quickly with still perfect technique was wrong. With increasing experience for myself, as well as my assistant and nursing team, our times have dropped significantly. Our longest operation was in excess of 3 hours still since some dissections take much more time depending on the anatomy.
I also performed a robotic simple prostatectomy which was the first one under 2 hours.
starbulletin.com: "Robot to aid surgeries at Queen's
The da Vinci system will first be used on prostate cancer cases
A robot called 'da Vinci' will begin work with surgeons this week at the Queen's Medical Center."
I blogged on this a few months ago, with my friend Dr Russell naming the next 2 states to obtain robots.
I believe the remaining states without robots are:
Montana, New Mexico, Vermont, and Wyoming
Seminars in Preventive and Alternative Medicine
| Under the guidance of Editor Mark A. Moyad, MD, MPH, Seminars in Preventive and Alternative Medicine provides a one-stop resource for the latest evidence on the use of alternative medicine in the prevention and treatment of chronic diseases, including cancer. In each quarterly issue, you will find critical analyses of alternative measures for both the prevention and treatment of chronic diseases, including comparisons of the efficacy of alternative versus traditional treatments.
Seminars in Preventive and Alternative Medicine will present information based on reports from clinical trials to provide guidance in developing individualized patient health plans. Dr. Moyad has developed a unique and fundamental framework for disease prevention that recognizes the importance of evidence-based, objective investigations of both alternative and traditional treatments. Seminars in Preventive and Alternative Medicine is a valuable resource for all practitioners treating patients with chronic diseases, such as breast cancer, colon cancer, prostate cancer, cardiovascular disease, obesity, diabetes, hypertension, Alzheimer's, osteoporosis, depression, arthritis and chronic pain |
One of the worlds leading authorities on alternative therapies, Dr. Mark Moyad (University of Michigan) has a journal which reviews the literature on alternative therapies to maintain a healthier life style and help minimize the chances of having diseases.
It is an excellent source of information for physicians, as well as patients.
