 |
Main
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.
edmontonsun.com - Edmonton News - $10M fundraiser in Edmonton aims to help combat prostate cancer
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.
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.
Dr. Tewari has added an additional technique to reconnect the anatomy in front of the connection site.
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 nephrectomy was the live telecast for intuitive surgical at the AUA.
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.
Robotic surgery on prostate cancer arrives in R.I. | Rhode Island news | Rhode Island news | projo.com | The Providence Journal
This is robot-assisted surgery — and some say it’s the future of surgery. Miriam Hospital is the first hospital in the state to acquire the robot, called the da Vinci Surgical System, which makes it easier to operate in the tighter corners of the human body.
Continue reading "Rhode Island joins robotic community" »
This past week, Intuitive Surgical participated in the 2007 AUA (American Urological Association) Meeting held in Anaheim, California. As noted, this years AUA Meeting was clearly the most prominent in the history of Intuitive Surgical.
We had a very strong showing with increased booth & program activities, higher visibility amongst leading academic & community urologists, 5 "Live" broadcasted da Vinci Procedures (including a formal AUA Satellite Live 3-D Broadcast) and a record attendance on the exhibit floor.
It was very clear that da Vinci Urology Procedures, such as dVP, are becoming routinely adopted across a larger audience of both urologists and hospitals. The ISI theme this year was focused on da Vinci Prostatectomy - "The Fastest Growing Treatment for Prostate Cancer", the launch of da Vinci Nephrectomy & the promotion of da Vinci S with HD (High Definition) This theme was promoted through the showing of "Live" Telesurgery, Continuous HD narrated & unedited 3-D video, New Clinical Data, New Robotic Techniques, & New Upcoming Instrumentation.
Key Highlights:
3 - AUA Sanctioned Robotic Courses focused on da Vinci Urological Procedures. Over 200 urologists paid and attended these courses
2 - AUA Sanctioned "Lunch with the Experts" Programs covering: Techniques, Maximizing Outcomes, & Getting Started with da Vinci in Your Practice
78 - Moderated Abstracts: (This was an increase of 279% over 2006. Abstracts in 2006 were 28). 2007 AUA Abstracts covered: dVP, da Vinci Pyeloplasty, da Vinci Cystectomy, da Vinci Nephrectomy, & others
AUA Plenary Presentation: Dr. Pat Casale (Children's Hospital of Philadelphia) gave an outstanding State-of-the ART Lecture presentation to an audience of more than 1,000 attendees titled, "The Application of Robotics in Pediatric Urology". Dr. Casale showed the da Vinci System as a valuable tool for the Pediatric Urologist. Procedure talking points and video clips covered da Vinci Pyeloplasty, Ureteral Reimplantation, Appendicovesicostomy, & several other reconstructive urological procedures.
This year the AUA & ISI held a Hands-On Course, where da Vinci Pediatric Urology procedures were featured utilizing 3 surgical stations (2 with da Vinci Systems & and 1 with computerized simulation from Mimic) . 40 urologists paid and attended this course. This course was taught by Dr. Craig Peters (University of Virginia), Dr. Pat Casale (Children's Hospital of Philadelphia), & Dr. Thomas Lendvay (Seattle Children's Hospital)
ISI Booth Presentations: Booth Presentations covered da Vinci Prostatectomy, da Vinci Nephrectomy & Partial Nephrectomy w/ 3-D HD Video, da Vinci Pyeloplasty, & da Vinci Cystectomy.
5 exceptional "Live" Telesurgery Broadcasts (4 -dVP and 1-dVN) drew packed crowds of hundreds to the ISI Booth & accompanied Satellite Program.
Dr. Ash Tewari (Cornell University) performed a beautiful bilateral Nerve-sparing dVP in a swift 60 minutes (console time) to an audience of 150+ urologists. His anastomosis time was under 5 minutes using da Vinci. This surgery was moderated by Dr. Peter Carroll (University of California San Francisco), Dr. Dave Albala (Duke University), Dr. Robert Meyers (Mayo Clinic Rochester) & Dr. Dan Barocas (Cornell University).
Dr. Ingolf Tuerk (Lahey Clinic) performed an impressive extra-peritoneal dVP (First ever broadcasted dVP technique to AUA). The moderator was Dr. John Libertino (Chair of Urology, Lahey Clinic).
Dr. Domenico Savatta (Newark Beth Israel Medical Center) performed a very efficient da Vinci Nephrectomy to a large audience utilizing the da Vinci S System. (First ever broadcasted dVN to AUA). This surgery was moderated by Dr. Jay Yew (Sharp Memorial Healthcare - San Diego)
Dr. Randy Fagin (Westlake Hospital) performed a 4-arm Bilateral Nerve-sparing dVP in a quick 60 minutes (console time) to an audience of 150+ urologists. This surgery was moderated by Dr. Naveen Kella (Georgia Urology)
Dr. Timothy Wilson (City of Hope National Medical Center) performed a 4-arm Bilateral Nerve-Sparing & Endopelvic Fascia Sparing dVP to a large group of curious urologists. City of Hope has now performed over 2,300 dVP procedures. This surgery was moderated by Dr. David Josephson (City of Hope).
Source: email end of May
Continue reading "AUA 2007 Recap for Intuitive Surgical" »
UroToday - AUA 2007 - Experience with Robotic-Assisted Laparoscopic Living Donor Nephrectomy
This series demonstrates that robotic-assisted laparoscopic donor nephrectomy can be performed safely with low complication rates and outcomes similar to standard laparoscopic living donor nephrectomy.
Continue reading "Robotic Donor Nephrectomy for donating a kidney for transplant" »
April has been traditionally a slow month in my practice. Last year it was the only month that I did less than 12 robotic surgeries (I only did 9).
This year I performed 16 robotic surgeries in April.
Continue reading "Robotic surgery summary- April 2007" »
The 1st quarter of 2007 was my busiest for da Vinci Prostatectomies (dvP) for prostate cancer (52 operations), as well as my busiest total robotic surgery 3 month period (60 operations).
My dvP volume increased 63% from the previous year and 24% from the previous quarter, which was then a record.
My total robotic surgery volume increased 50% from the previous year and 15% from the previous quarter, which was then a record as well.
Continue reading "Robotic Prostate Surgery- 1st quarter update" »
First heart surgery performed by robots in CzechRep - Prague Daily Monitor
First heart surgery performed by robots in CzechRep
By Prague Daily Monitor/ČTK / Published 16 March 2007
 Prague, March 15 (CTK) - The first robotic heart operation was performed in the Czech Republic in Prague's Na Homolce hospital this week, hospital spokeswoman Jitka Kalouskova told CTK today.
Six patients suffering from heart failure underwent the unique operation using robotic systems.
The hospital, which holds an international quality accreditation, ranks among pioneers in robotic operations in the Czech Republic. It opened a robotic operating theatre in October 2005.
Straus Newspapers - Advertiser News / News: Robotic surgery brings tomorrow’s surgical techniques to Saint Clare’s today
DENVILLE — As part of its ongoing commitment to provide the latest in medical
care and technology to its patients in the communities in which they live, Saint
Clare’s has announced that it performed its first robot-assisted, minimally
invasive surgery on March 1, following successful deployment of the da Vinci S
Surgical System at Saint Clare’s Hospital, in Denville.
This unique system, from Intuitive Surgical, the world’s leading innovator of robotic
surgery technology, couples advanced surgical instrumentation and 3-D
visualization with ergonomic comfort while bringing the future of surgery to our
community.
St. Clares is a very nice community hospital in Denville, NJ. It has the first daVinci S robot in Morris county, where I live. One of my friends is doing robotic surgery there now and I am awaiting privileges to bring some of my robotic cases to Denville.
My partner currently performs most of my ESWL (shock wave surgery) there for me currently.
This is the monthly report on my robotic surgery practice in West Orange, NJ.
It was a relatively slow month. I performed 11 dvPs, and no other robotic surgery.
The main reason was a prostate conference/ vacation that I took. I went away for 7 days and did not schedule any surgery the week I was going away, so I was restricted to 2 1/2 weeks of surgery.
I had 1 important development. I developed a new technique for large median lobes that I am in the process of submitting to a journal. I think this technique will be the preferred way to approach large median lobes.
I also presented an important poster at the Prostate Cancer Symposium (a multidisciplinary international prostate cancer meeting), which I will write about later.
Click on picture to enlarge
Continue reading "Robotic Surgery Update- February 2007 with a focus on robotic times" »
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.
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
This is a monthly update on the growth of Robotic Surgery in my practice.
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).
Continue reading "Robotic Surgery Growth: End of 2006" »
November 2006 robotic breakdown
For November I performed 21 robotic operations: 15 robotic prostate removals (dvP), 2 removals of a part of a kidney (robotic simple nephrectomy), 1 kidney (robotic nephrectomy), 2 removals of parts of a prostate for BPH (simple prostatectomy), and 1 reconstruction.
This was the 1st month that I performed 20 robotic surgeries.
The operations of note were:
The removal of a 27 cm kidney tumor. I think this was the record for largest kidney removed by a robotic system. This was for a benign tumor.
2 robotic simple prostatectomies for BPH. One was done with a new intravesical technique and also had many bladder stones removed.
The other was our 2nd largest prostate.
We removed our first prostate over 100 gms in less than 2 hours (122 gms in 100 minutes). I have developed a new technique for these large prostates that is less traumatic on the bladder and quicker than the usual way. We did a record 200 gram prostate in December using the same technique.
Da Vinci puts magical touch on the prostate | Health | The Australian
One of the five robots in the UK is at the London Clinic. It has proved so successful that professor Roger Kirby, and his anaesthetist Peter Amorosa, now do most of the radical prostatectomies using a robot rather than hands-in and hands-on open surgery. Kirby did his 100th robot-assisted prostatectomy last week.
100 cases is an impressive milestone for one surgeon.
I wish Dr. Roger Kirby success on his next 100.
London Free Press - City & Region - People . . . You Know:
"In Canada, there are only three Da Vinci robotic surgical systems. Two of them are in London. One operates out of C-Star, the other, at St. Joseph's Hospital, is used primarily for clinical care. "
I wonder how many daVinci robots the Canadians need?
ekathimerini.com The mechanical arms...: "The mechanical arms of the first robotic machine capable of performing surgery were seen yesterday when the Da Vinci robotic system was presented by the private Athens Medical Center."
It is not very clear if the robot was passing through, but it appears that this unit in Athens may be the first in Greece.
View chart of Dr. Savatta's robotic surgery growth
For October I performed 15 robotic operations, 12 robotic prostate removals, 1 removal of part of a kidney, and 1 bladder and prostate for bladder cancer.
I have performed 130 robotic prostatectomies in the last 12 months and 113 so far this year.
In the last year I have performed 167 total robotic operations in the last 12 months and 143 so far this year.
The growth is increasing and I have a record amount of robotic surgery cases scheduled, about 30. The operating room times I have decreased with even my newer techniques at nerve sparing to the point where we can comfortably do 3 robotic operations in 1 day.
We are getting close to 20 per month, which will probably be as much as I can do by myself. Our group is recruiting a robotic surgeon to joining us next summer which should help the program grow further.
The operations of note were:
A robotic prostatectomy after failed cryosurgery. This was my first and was more difficult than the typical prostatectomy after radiation.
I also did a dvP on the largest patient. His BMI was 43. The surgery took a little over 3 hours with lymph nodes and went very well. His catheter was removed in 1 week.
I performed my most difficult prostatectomy. I thought it was going to be easy, but found several congenital abnormalities including bilateral ureteroceles, extra bladder tissue at the bladder neck, and abnormal vasculature. It took over 4 hours, but I successfully was able to perform the operation robotically.
I performed my first repeat robotic operation. A patient of mine who had a robotic partial nephrectomy now had a robotic prostatectomy. I have a second patient who had a robotic nephrectomy scheduled for a robotic prostatectomy as well. I believe these are the first patients who will have benefited from robotic surgery more than once.
Delawareonline : The News Journal : St. Francis to use da Vinci system
Delaware was one of the few states that did not have a daVinci robot. I believe this will leave only Hawaii, Montana, New Mexico, Rhode Island, Vermont, and Wyoming as states that do not have one yet according to the intuitive surgical website.
Anyone care to guess which state will get one next.
Oak Ridge, Tennessee: Oak Ridger - news
I am famiiar with Oak Ridge. A friend and fellow IU Urology grad of 2003 has a practice there.
It is nice to see robotics making it to smaller towns in the US and I am sure Dr. James Sloan will find good use for it.
Robotic surgery growth chart
In September I performed 15 robotic operations.
We had a patient that travelled the farthest to date to have surgery at Newark Beth Israel. He came from Italy for a robotic prostatectomy and flew home after 15 days with minimal problems.
I also performed 6 kidney operations for cancer. One was removing part of a kidney, 4 were removing the whole kidney and 1 involved removing a kidney, ureter, and part of a bladder.
The latter operation truly showed how useful robotic surgery can be. The gentleman is 80 years old and was very anemic to start with. He had prior surgery and radiation in areas that needed to be removed. He was also very anemic and was able to go home 3 days after the surgery without prescription pain pills and without needing a blood transfusion. Prior to robotics I would have done the bladder part of the operation open which would have meant a blood transfusion and a longer hospital stay.
View chart of Dr Savatta's robotic volume
This is a monthly update on the growth of Robotic Surgery in my practice.
In August I performed 12 robotic operations. 10 were daVinci prostatetcomies for prostate cancer, 1 was a nephrectomy for cancer, and 1 was a partial nephrectomy for cancer. The total number of robotic prostatectomies I have performed is 153 and robotic operations is 194.
Continue reading "Robotic Surgery Growth: August 06 update" »
This is a monthly update on the growth of Robotic Surgery in my practice.
In July I performed 17 robotic operations. 14 were daVinci prostatetcomies for prostate cancer, 1 was a robotic simple prostatectomy for BPH, and 2 were kidney removals for kidney cancer. The total number of robotic prostatectomies I have performed is 143 and robotic operations is 182.
At the time of my robotic prostatectomies, my team also performed 3 robotic inguinal hernia repairs.
Continue reading "Robotic Surgery Growth: July 06 update" »
This is a monthly update on the growth of Robotic Surgery in my practice.
In June I performed 18 robotic operations. 17 were daVinci prostatetcomies for prostate cancer and 1 was a robotic nephro-ureterectomy. The total number of robotic prostatectomies is 129 and robotic operations is 165.
At the time of my robotic prostatectomies, my team also performed a robotic gallbladder removal in 1 patient and 3 robotic inguinal hernia repairs.
Continue reading "Robotic Surgery Summary- June 06: focus: performing general surgery operations at the time of robotic prostatectomy" »
Source: Huntington News
I believe this will be the 2nd robot in the state.
This is a monthly update on the growth of Robotic Surgery in my practice.
May of 2006 was my busiest robotic surgery month to date. I performed the most operations (17) and the most non-dvP robotic operations (6) to date. With 2 robots and a world class surgical assistant, my schedule is now only limited by how many operations I can do with my schedule.
In May I performed 17 robotic operations. There were many highlights this month:
Continue reading "Robotic Surgery Growth in New Jersey- Beyond prostate cancer" »
I have been selected to perform a live tecast from Newark Beth Israel Medical Center to the AUA conference in Atlanta on May 22nd. Any urologists interested in observing can go to the intuitive booth at noon.
This is a monthly update on the growth of Robotic Surgery in my practice.
Due to a variety of reasons, this month was my slowest robotic surgical month of the last 7. 2 months ago I explained that I have been restricting use of the da vinci robot to prostate surgery. I am happy to report that our da Vinci S has found a new home in a state of the art laparoscopic suite and our da Vinci standard is back in its old room, waiting for the completion of our last 2 new ORs.
In April I performed 9 robotic operations. One was possibly the worlds first robotic bladder diverticulectomy. The other 8 were da Vinci Prostatectomies. To date I have performed 130 robotic operations
.
Continue reading "Robotic Surgery Growth in New Jersey: Essex county" »
This is a monthly update on the growth of Robotic Surgery in my practice.
As I explained last month, I have been restricting use of the da vinci robot to prostate surgery. Until our second robot is operational on a regular basis, I have been mostly performing davinci prostatectomy (dvP) for prostate cancer.
In March, despite one week of vacation, I performed 13 robotic operations. One was an elderly gentleman who had a robotic cystoprostatectomy. The other 12 were dvPs. To date I have performed 121 robotic operations with 93 done for prostate cancer (77%).
Continue reading "Robotic Surgery Growth in New Jersey: Focus Prostate Cancer Surgery" »
This is a monthly update on the growth of Robotic Surgery in my practice.
Original blog entry about robotic surgery growth was in November of 2005 and is updated monthly.
For January, I performed 14 robotic operations including 9 prostate removals for cancer, 3 kidney removals for tumor, one ureteral reimplant, and a bladder and prostate removal in an elderly gentleman.
Continue reading "Robotic Surgery Growth in New Jersey (Essex County)- January 2006 Update" »
Robotic general surgery guru will be in Dubai for Arab Health
Source: AME info
Dr. Susan Lim will be speaking in Dubai for Arab Health Conference
| Dr. Lim, who
is the pioneer in Robotic general surgery both in Singapore and in Asia
since 2004 and to date is the leader in the field, believes most respected
hospitals in the world will be using robots to perform some of the most
complex surgeries without making large incisions. |
The true robotic surgery pioneers were in Europe. Hospitals in Europe were buying robotic surgical systems in higher quantity than hospitals in the United States several years ago. The largest early series were from France. Recently most sales were going to hospitals in the United States.
From an article in The Prague Post, it seems that the future of robotic surgery is bright in The Czech Republic as well now. They have performed over 25 robotic procedures and other hospitals are considering purchasing the daVinci robotic system.
This is a monthly update on the growth of Robotic Surgery in my practice.
Original blog entry about robotic surgery growth was in November of this year and was updated in December.
For December, I performed 13 robotic operations including 9 prostate removals for cancer, 1 kidney removal for a kidney that was causing pain and was enlarged about 20 times normal and did not work, as well as removing 2 parts of kidneys for cancer.
Continue reading "Robotic Surgery Growth in Essex county, NJ- December 2005 Update" »
This is an update from a previous blog entry on robotic surgery growth.
In Nov I performed 10 robotic operations and assisted Dr. Adam Kopelan with a robotic adrenalectomy. Dr. Kopelan is a general surgeon specializing in laparoscopy and one of the few robotic general surgeons. He usually assists me at the field for cases when a urologist and general surgeon are useful including robotic cystectomies, lysis of adhesions prior to prostatectomy, and laparoscopic/robotic hernia repairs in conjunction with prostatectomy.
The most significant days were:
Nov. 21- Dr Kopelan assisted me for the first robotic anterior exenteration performed in the tristate (lower NY, CT, NJ) area.
Nov 30- Dr. Galdieri assisted me in performing 3 dvps in 1 day and all were discharged within 20 hours of surgery.
We started our robotic surgery program at Newark Beth Israel Hospital on Dec. 13th, 2004.
Our 9 man group decided to let one person do all of the robotic surgery. Since I had the best combination of open and laparoscopic surgical skils, as well as strong cancer training from a 6 year residency at Indiana University, I had the fortune of being the person.
We did 2 cases in Dec, 2004 (both prostates). We did between 1 (Feb 05) and 7 cases per month from Jan to Sep 0f 2005 for a total of 42 operations (including 32 prostates).
We then jumped to 13 operations (10 prostates) in Oct 2005 and should do about that many in Nov and Dec of 2005.
I project I will do 200 operations (150 prostates) in 2006.
Why?
Continue reading "Robotic Surgery Growth" »
This is one of the most common questions I am asked.
Patients want to know if their surgeon is qualified to do a procedure.
I always answer this question honestly and to the best of my knowledge. With robotic cases I keep accurate data on outcomes and can answer this precisely.
I then add "How many is enough to know how to do the procedure?"
Continue reading "How may robotic prostate surgeries have you done?" »
|
| 
| 
