I have previously written about sexual function and how it changes after prostate cancer surgery. As men are being diagnosed with prostate cancer at a younger age and at an earlier stage, the preservation of erectile function and the ability to maintain satisfactory erections has become more important. My partners and I offer a variety of options to assist in the recovery of erections including having a vacuum device specialist come in to the office once a month, teaching patients how to give penile injections and intra-urethral suppositories, and prescribing viagra, levitra, and cialis on a maintenance, preventative basis.
I was honored to be chosen as a top physician in NJ by my peers. This meant a lot to me after being in practice in NJ for only 4 1/2 years. I want to congratulate my partners who shared in this honor: Dr. Eric Seaman and Dr. Yithak Berger.
As my friends and readers know, in May of 2007 I performed a live right kidney and adrenal gland removal for intuitive surgical. This was telecast to the AUA conference in Anaheim. My hospital helped me edit the video which I did a voice-over for and made into a nice 7 minute piece. I was told it was going on our hospitals website.
I then received an email that it was put on you tube. I am not sure how I feel about this. Exposure is good, but is this the correct forum? I have personally put videos on google video before, but not you tube.
I think the piece is pretty neat and can be viewed below.
I welcome comments about using youtube or other media to promote work. I think surgeons can learn by watching this piece and will find it interesting, but I wonder how it will be perceived.
The study team recorded critical failures in 20 cases (0.3%) leading to the cancellation of 10 procedures and conversion to laparoscopic in one case and to open procedure in nine cases. Recoverable failures were more frequent, occurring in 124 instances (1.9%). The most common malfunctions or failures occurred in the optical system and in the surgical arms. Failure of the master system or power system was less common.
Dr. Patel did not ask me to be in this studay, but my experience is simlar. I have 2 failures during my robotic surgery cases. 1 wa sduring a kidney removal operation and we converted to laparoscopy.
The other was during a prostate removal when we brough in one of the other 2 robots. Thats 2 in almost 500 operations.
We also had 1 cancellation, 1 delayed start, and 2 other cases that were done with only 3 arms.
I would call that 2 major problems and 4 minor problems.
An Edmonton hospital is tackling prostate cancer with a $10-million fundraiser to open a prostate health clinic, purchase a robotic surgery system and increase its research fund.
Fundraising will likely bring another robotic system to Canda.
For more than a decade, HIFU has been investigated as a less invasive alternative to surgical treatment in men with localized prostate cancer. A growing and maturing body of research suggests that HIFU is a safe and efficacious option for several subgroups of patients.
I am still skeptical of long term cancer cures of HIFU for prostate cancer, but I expect it to be in the USA in the next 2-3 years. Reading the article shows that there have been advances since I was involved with HIFU research 6 years ago at Indiana University.
This was a good review of the current technology and side effects and early outcomes.
Important negatives that the article point out are the difficulty in treating large prostates. They recommend treating the prostate before HIFU hormones (which have side effects of hot flashes, mood swings, etc.), a TURP (which can be very bloody in large prostates, or treatment with 2 rounds of HIFU. This last option is most attractive in my opinion if you have a large prostate and elect to have HIFU.
The other negative is the use of a foley catheter (2-7 days) which is similar to my catheter length after dvP. Patients also need a suprapubic catheter which is not needed with dvP.
My last issue is the suggestion that a negative biopsy is similar to a cure. A biopsy will only sample a small part of the prostate and longer followup will be needed to see how many cancer cells will not be destroyed and lead to clinical failures.
In September I performed 19 operations including 13 dvPs.
One simple prostatectomy was combined with a left inguinal hernia repair. This was the first time I had performed this combination, although I have performed close to 50 hernia repairs at the time of dvP.
The new thing to report is an improvement in continence that I have seen after adding a few sets of sutures to re-construct the pelvic anatomy after removal of the prostate and before the connection is made. I had been doing part of this since I read a paper from Rocco describing his procedure of repairing anatomy behind the connection of the bladder to the urethra. This addition has helped more men achieve quicker urinary control in my experience.
I have added some of my own modification and have seen a nice short term improvement in urinary control. The best part is that the cancer control has not been compromised in these patients and my positive margin rate has declined.
For the summer months I had the pleasure of inviting my new associate, Dr. Brent Yanke, into our practice.
We spent July together and he is now on his own performing most of his robotic surgery. He was well trained at Thomas Jefferson and had participated in over 100 robotic operations.
In July and August I performed 30 robotic surgeries, including 22 dvPs, a pyeloplasty, 3 nephrectomies, 1 nephro-ureterectomy, a lymph node dissection for testicular cancer, a simple prostatectomy, and a nerve-sparing cysto-prostatetcomy and neobladder for bladder cancer.
The most important accomplishment was the bladder cancer operation. This was the first time that I have made a new bladder with the robot. Our patient had only a small incision in the lower abdomen to remove the specimen and went home in 3 days.
I have been neglectful during the summer with keeping up on my blog.
I will hope to catch up and keep my monthly postings of how things are going in my practice.
In May and June I performed 32 dvPs, a nephrectomy, a simple prostatectomy, and a partial nephrectomy.
The cystectomy was notable because it was the first time that my team and I did a closed urinary diversion. Traditionally, we have been performing the second half of the operation with a small incision. This time we made an ileal conduit with the daVinci robot as well.
The simple prostatectomy was my 10th, giving me one of the worlds largest experience.
Men who choose surgery for early prostate cancer are more likely to be alive 10 years later than men who opt for other treatments, a Swiss study shows.
"If you look not only at this study but at the studies we brought out in the last three or four years, in terms of survival for 10 or even 15 years, there is a distinct advantage in patients who underwent surgery for localized prostate cancer," Tewari tells WebMD. "This has implications for patients comparing different treatment options."
Robotic-assisted RC appears to offer some operative and perioperative benefits compared with the open approach without compromising pathological measures of early oncological efficacy, such as lymph node yield and margin status. Larger, randomized studies with long-term follow-up are required to confirm these findings and establish oncological equivalence
I have been performing robotic cystectomies for almost 2 years now and have seen similar results. The patients with less cancer in this study have been selected for robotics and teh more difficult ones were usually done open. This makes the data harder to analyze.
I have been able to do most of my bladder cancer surgeries robotically in the last year, mostly due to increasing experience and having a daVinci S robot, which allows for a wider range of movements. My operating room times are now similar between open and robotic.
I expect this operation to change from an open to robotic as more institutions gain more experience with robotic surgery.
In this study, experience was measured not by age or years as a surgeon but by the number of times doctors performed this operation.
"Advice for patients is to try to seek out experienced surgeons, and they're likely to be ones who specialize in the procedure," Andrew Vickers of Memorial Sloan-Kettering Cancer Center in New York City, one of the researchers, said in a telephone interview.
The researchers followed 7,765 prostate cancer patients who underwent an operation called radical prostatectomy performed by 72 surgeons at four U.S. academic medical centers in New York, Texas, Michigan and Ohio from 1987 to 2003.
As the number of times a doctor performed it increased, the number of patients who remained cancer-free five years after the surgery also rose, the researchers wrote in the Journal of the National Cancer Institute.
But at a certain point the improvement in surgical outcome topped out and stabilized regardless of how many more times a surgeon did the procedure.
"The learning curve for prostate cancer recurrence after radical prostatectomy was steep and did not start to plateau until a surgeon had completed approximately 250 prior operations," the researchers wrote.
Surgeons should not be judged on their age or years of experience (35 years old and 8 years of experience for me), but by the number of prostates they have removed. This is one of many studies that shows better cure rates from more experienced surgeons.
This study looked at open surgeries, but I think robotics will also be similar. My personal numbers are over 500 prostatectomies of all types and over 350 robotic prostatectomies.
A surgical team led by Dr. Pier Cristoforo Giulianotti, chief of the division of minimally invasive, general and robotic surgery at the University of Illinois Medical Center at Chicago, has performed the first fully robotic Whipple procedure in the Midwest.
The operation, also called a pancreaticoduodenectomy, is the most common surgical treatment for cancerous or benign tumors of the head of the pancreas. The procedure involves removal of the gallbladder, bile duct, part of the stomach and duodenum, and the head of the pancreas.
"The Whipple operation is one of the most demanding surgical procedures of the abdomen," said Giulianotti, the Lloyd M. Nyhus Professor of Surgery at UIC. "It generally requires a very long abdominal incision to expose the pancreas and other organs, significant manipulation of the bowel, post-operative pain, and a greater chance of complications."
In 2003, Giulianotti performed the first robotic Whipple procedure in the world while practicing in Italy. Since then, he has performed more than 40 such operations.
I had the opportunity to meet Dr. Giulianotti, a very impressive person to speak to about robotic surgery. I look forward to reading about his upcoming accomplishments.
I am not personally that impressed with HIFU from what I have been reading and from my research at Indiana.
This series shows a relatively high failure rate of almost 30% and over 30% of patients having trouble with erections even though 23% of patients needed re-treatment.
My other main concern is how patients will fo after failing and needing surgery, which will be more complicated and have more side effects than primary surgery.
