In October and November I performed 46 robotic surgeries, including 35 dvPs, 4 partial nephrectomies, 2 nephrectomies, 2 radical cystectomies including a bladder replacement in a woman, 1 simple prostatectomy, a stone procedure to remove a large left kidney stone, and a removal of a piece of ureter and re-implant for ureteral cancer.

The most important operation was the anterior exenteration (removal of bladder) and bladder replacement in a female, the first operation to be done completely robotic for me of this type.

One nice trend I have been noticing is a significant improvement in the recovery of urinary control with the reconstruction sutures I have added to the robotic prostatectomy. Most patients are having decent control by 4-6 weeks. I will be looking at the data in more detail in a few months to see how much of an improvement the addition of these sutures has added.

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clipped from www.prostatecancerfoundation.org

Report to the Nation on Prostate Cancer: A Guide for Men and Their Families

Being diagnosed with prostate cancer can be a life-altering experience. It requires making some very difficult decisions about treatments that can affect not only the life of the man diagnosed, but also the lives of his family members in significant ways for many years to come.

More than 218,000 men in the United States will be diagnosed with prostate cancer this year, and each and every one of them will need to make very personal and individualized decisions about treatment options and diet and lifestyle changes.

But most importantly, each and every one of them will have to find a strong, knowledgeable team of physicians, nurses and other healthcare providers to help guide him through the process at each step of the way.

This book is about 100 pages, half dedicated to treating early prostate cancer and the other half discussing treatment of hormonal therapy and late stages of prostate cancer. It has a downloadable version of the book or you can request a free copy through the website of the prostate cancer foundation.

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UroToday - WCE 2007 - Single Knot Anastomosis (SKA) For Laparoscopic Radical Prostatectomy: An International Multicenter Outcome Survey of 5235 Cases

They have shown that the time to complete the anastomosis for the expert, second generation, and trainee surgeons were 16, 23, and 30 minutes respectively. Additional stitches were necessary only in 1.1%. The anastomosis was water tight in 94.2%. Early leakage requiring prolonged catheter drainage occurred 6.8% of laparoscopic cases and 0% in the robotic assisted cases. Mean catheter time was 7.1 days. The bladder neck contracture rate was 0.8% at 12 months and the rate of acute urinary retention was 0.5%.

Dr. van Velthoven deserves credit dor being the first to devise a simpler, likely better way to make the bladder to urethra connection. Most surgeons, including myself, use this technique.
This large series shows the average time for a connection is 16 minutes and the average catheter is kept in for 1 week.
Some surgeons catheter times are much faster. I have watched Dr Patel and Dr Tewari perform the connection in well under 10 minutes, probably about 5.

My main work currently is trying to reduce the catheter time to as a few days as possible. I think with robotics we can cut down the catheter time to 3 days at least.

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