Additionally, real-time integrated video and communications systems from Black Diamond Video will place Saint Clare’s in the company of renowned health care organizations with the same technology, such as Cleveland Clinic, Duke, Mass General and Yale, among other select hospitals nationally.
I have been performing robotic surgery at Saint Clare’s for 5 years. I am fortunate to work with a dedicated team of nurses and anesthesiologists and my partner, Dr Alex Gelllman when I perform my robotic prostatectomies there. I was very pleased to learn about the upgrade to the davinci Si platform and the new operating rooms. This should be a benefit to Dr Gellman’s and I andn our patients.
Urological surgeons should be encouraged to perform a thorough inguinal exam during preoperative evaluation and intraoperatively to detect subclinical hernias. Inguinal herniorrhaphy done concurrently at the time of RALP is safe, with no added morbidity and should be routinely performed.
This is a paper Dr. Ahlering and I wrote which is a review of our results and techniques of fixing hernias during dvP.
Since conferring with Dr Ahlering on this paper, I have changed my technique to resemble his more.
The main point of the article is that hernias are common and it is beneficial for patients to have them fixed.
We report a large, multi-institutional series of RPN for renal tumors, confirming safety and feasibility reported in previous small, single-institution studies. Although we report the initial experience in RPN at each center, immediate oncologic results and perioperative outcomes approached those of more mature laparoscopic series. Robotic assistance may facilitate the technical challenges of precise tumor resection and renal reconstruction within acceptable warm ischemia times. Long-term outcomes are needed to establish the role of RPN in nephron-sparing surgery.
This was a large multi-institutional study that I was part of. This was the largest robotic partial nephrectomy study reported.
“Briefly, higher hospital and surgeon volumes are associated with a decreased risk of most in-hospital complications after RP,” the team concludes.
They add: “These associations are statistically significant and likely to be clinically important, especially if doubling hospital or surgical volume can lead to an 8% to 9% decrease in the rate of any complication.”
Another study, this one from Canada, showing that hospital and surgeon volume are both related to lower rates of complications for prostate cancer surgery.
I am pleased to say that I am close to 500 robotic prostatectomies and my partner and I have combined for over 600.
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.
Eric P. Newman Education Center
Washington University Medical Center – St. Louis, Missouri
Sam B. Bhayani, M.D.
The Division of Urologic Surgery
Washington University School of Medicine
Continuing Medical Education
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.
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.
Click picture for readable size.
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.
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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.