| Robotic Surgery Blog
From Washington Post.com
"This reaffirms what many other manuscripts have shown, if you go to an individual who has experience, who does this on a consistent basis, your outcomes will be better," said Dr. Ihor S. Sawczuk, chief of urologic oncology for the Cancer Center at Hackensack University Medical Center, in New Jersey. "If you go to someone who does 20 to 50 procedures a year, that's better than somebody who only does two to three a year."
The only study I am aware of does not sure a large difference between the open and minimally invasive prostate cancer surgeries.
I agree with Dr. Sawczuk, a friend and colleague, that more experienced surgeons are more likely to have better results. The surgeon is important, probably more so than the technique. I think the best way to analyze this would have been to set up a study looking at high volume robotic vs. lap vs. open surgeons andhaving a 3rd party analyze the results. I do not think this is something that would ever be done.
My feeling after performing many open prostate cancer surgeries, a few laparoscopic ones, and over 400 robotic ones is that robotics gives me the ability to perform more accurate surgery, and the difference is more pronounced with more difficult cases.
Being able to remove the catheter within 3 days routinely without needing X-Rays would be difficult for me to achieve with open or laparoscopic surgery.
From Urotoday
Functional results with regard to erectile function and urinary continence after prostate sparing cystectomy are good. Oncological results have been promising, but need to be confirmed after longer followup and in larger trials.
For men in need of a bladder removal for bladder cancer, my practice has always consisted of removing the entire prostate as well. This is what I learned at Indiana and have continued to do in NJ. As far as I know, urologic oncologists in the USA all agree on this.
In Europe I have read several studies that have left the prostate capsule or most of the prostate in place. I think you will see a higher rate of pelvic recurrences and bladder cancer recurrence in the prostate, as well as new prostate cancers this way. I do agree that men will have less side effects in regards to erections and continence potentially.
I have been performing robotic cystectomies for about 3 years now and feel that I can perform a more careful operation around the erection nerves and urinary muscles. I hope to improve on our past results while still removing the entire prostate wih the bladder.
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From UroToday
Surgical waiting time from initial urological consultation to operative intervention does not adversely affect the outcome of renal cell carcinoma within the time frames analyzed in this study, in which 94% of cases occurred within 3 months. Individual urologist judgment remains a critical factor in the appropriate and timely care of the patient with a suspicious renal mass.
Patients often ask how soon they have to have surgery when diagnosed with a likely cancer. This study shows that for kidney cancer it does not seem to make much of a diffference. The main problem with tihs study is that patients with larger tumors often get counselled to have surgery right away, whereas smaller ones are often given the option to wait a few months if the patient wants to.
From Urology Times
Spanish researchers have found a means of distinguishing between high-grade prostatic intraepithelial neoplasia (HGPIN) lesions destined to become cancerous and those that will remain benign, which may spare patients the discomfort and inconvenience of unnecessary needle biopsies, according to a study in Clinical Cancer Research (2008; 14:2617-22).
This is teh first studay that I am familiar with that has a genetic marker for patients with diagnosis of high grade PIN. High grade PIN was once thought to be higly associated with prostate cancer (about 50%) and warranted a repeat biopsy. This was when urologists performed 6 biopsies routinely.
Now that we are performing at least 10, the finding is not as ominous as before. About 20% of pateints wil develop cancer.
First Annual Worldwide Robotic Renal Symposium
I had the honor of being selected on the faculty for the 1st robotic conference dedicated to kidney surgery. This should be an excellent conference for urologists who are performing robotic surgery for prostate cancer and would like to learn about current techniques for kidney surgery including partial nephrectomy. Transplant surgeons who currently perform laparoscopic donor nephrectomies and would like to learn about robotic surgery are also good candidates.
Location:
Eric P. Newman Education Center
Washington University Medical Center - St. Louis, Missouri
Course Chair:
Sam B. Bhayani, M.D.
Presented By:
The Division of Urologic Surgery
Sponsored By:
Washington University School of Medicine
Continuing Medical Education
Medscape article summarizing PSA recommendations:
The most aggressive screening protocol is from the NCCN.
NCCN guidelines start from the premise that the patient has made a decision to seek early prostate cancer detection. They recommend beginning screening at age 40. The baseline PSA level, race, and family history are then used to determine the subsequent screening intervals. They recommend considering a biopsy for men with a total PSA level > 2.5 ng/mL, after further consideration of the PSA velocity, PSA density, and percent free PSA. They explain how these parameters can be used to lessen the possibility of confounding from benign prostatic hyperplasia. Furthermore, they describe how repeating PSA determinations with or without a trial of antibiotic therapy, as well as consideration of variability between different PSA assays, can reduce the likelihood of confounding from prostatitis or differences in PSA assay standardization. Moreover, they provide advice about whether or not repeat biopsies are needed and how to deal with the findings of high-grade prostatic intraepithelial neoplasia or atypical glands suspicious for carcinoma on an initial biopsy.
New Study Compares Tort Systems -- Reform Improves Health Care for Patients
A new study by the Pacific Research Institute, US Tort Liability Index: 2008 Report, measures the best and worst tort systems in America. In the report, the authors examine evidence provided by top economists and legal scholars on the benefits of tort reform in peoples' lives and conclude that, among other things, reform improves health care and health care access. The report also discusses the cost of defensive medicine - most of which is prompted by medical liability concerns - which has now reached the astounding total of $163 billion a year. This is the sum of the direct costs of defensive medicine, estimated to be $124 billion a year by PriceWaterhouse Coopers, and PRI's own estimate of the $39 billion indirect costs from lost productivity due to reduced access to health care attributable to defensive medicine. According to PRI, increased health-care costs brought on by defensive medicine have also added some 3.4 million Americans to the rolls of the uninsured.
I used to work in Indiana, which has one of the more doctor friendly malpractice systems. Potential lawsuits are brought before a panel for an opinion prior to a lawsuit being filed. Indiana also has a cap, or limit, on how much money a plaintiff can win for pain and suffering. All this led to low malpractice insurance costs. In New Jersey it is quite different.
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