Dr. Savatta’s personal blog

Thoughts from a robotic surgeon

I have started this blog to express some of my personal thoughts.
I started the robotic surgery blog (http://www.roboticsurgeryblog/) 16 months ago and will still write there along with several other robotic surgeons.
I wanted a forum that I could share my more personal thoughts, some maybe controversial or personal.
I also wanted a place to put my patient’s testimonials and letters that was separate from the robotic surgery blog.
I also like blogger for quick-posting and to link easily to other blogger blogs.

After blogging for almost a year and a half here, I wanted a forum to express some of my thoughts that are not robotically based.
I started with an entry on where my patients have travelled from for minimally invasive surgery: 4 continents, 6 countries, and 10 states.

Welcome to a medical oncology blogger

Dr.Kattlove’s Cancer Blog:

If you have prostate cancer, that isn’t a bad idea.
Recently surgeons from Detroit’s Henry Ford Hospitals reported their
outcomes using the da Vinci robotic system in over 2500 men (European
Urology 2007;51:648-58). With the da Vinci, which has been in use in the
U.S. for prostate cancer surgery since 2000, the surgeon doesn’t actually
do any cutting – he or she just turns dials. The instrument, which has
telescopic lenses for super vision and lots of little arms for cutting and
suturing, actually does the surgery. Also, instead of an incision,
everything is done through 6 tiny holes. The instruments and telescopes
are passed through the holes to do their work.

Dr. Kattlove is a little off with some of his takes on robotics, but it is nice to see an experienced medical oncologist start blogging. I look forward to reading his blog. Welcome.

Choosing a prostate cancer therapy option for a patient who doesn’t have the capacity to understand the options

When I first saw this patient, there was a note in
the chart from the front desk saying “patient does not read”. I asked if
this was a deliberate decision from the patient, or whether they had meant
to say that the patient was illiterate and could not read.

Unfortunately, the latter is true. The patient is a retired janitor who is
somewhat “developmentally delayed” (I think that’s the current correct
term), and has never been able to learn to read. He has no family and is
functional enough that he does not have a guardian or someone with power
of attorney.

This poses a difficult situation because I diagnosed him with prostate
cancer after doing a biopsy, and tried to explain to him all the options
available for treatment. Prostate cancer is a disease where there are
several treatments choices available (surgery – open or laparoscopic-,
external beam radiation, brachytherapy, cryotherapy, observation etc…),
and the urologist and the patient arrive to a decision together after much
discussion.

Well, there wasn’t much of a discussion with this patient because he did
not truly understand all risks and benefits involved with each option. I
did send him to see the radiation oncologist who agreed with me that the
patient has limited comprehension about the options.

The patient is quite pleasant. He will follow all the instructions we give
him, and our staff has been working extra hard to call and remind him of
all his medical appointments (X-ray, labs, office visits etc…). But this
is a tricky situation. The patient obviously needs treatment, and I am in
the awkward position of deciding for him what the next step should be.

This was an interesting dilemma a colleague of mine faces as she write son
her blog.

My response

This is a great post and will add it to my blog to see what my readers think.
I have to preface my answer with the disclosure that I am a urologist who does
4-6 robotic prostatectomies per week.
I always recommend a second opinion and often have patients ask me to decide for
them.
I had one patient who I biopsied who was very similar to yours, but fortunately
did not have cancer.
My suggestion to you would be to choose for him what you would do for your dad
if it was him.
If you think incontinence would be too much, then radiation has a major
advantage. If you feel that anesthesia is best to be avoided, then external beam
would be the way to go.
If he is young and needs surgery in your opinion, I would recommend that.
The society frowns upon paternalistic physicians (and probably rightfully so),
but this is a good example of paternalism working well.
Good luck.

Excellent medical blog- From an excellent hospital’s CEO



Running a hospital blog entry:
da Vinci Uncoded — or, Surgical Robots
Unite!

Here you have it folks — the problem facing every hospital, and
especially every academic medical center. Do I spend over $1 million on
a machine that has no proven incremental value for patients, so that our
doctors can become adept at using it and stay up-to-date with the “state
of the art”, so that I can then spend more money marketing it, and so
that I can protect profitable market share against similar moves by my
competitors?

This entry caught my attention since it discussed robotic surgery.
It is from the blog of the CEO at Beth Israel Deaconess Medical Center in Boston. He seems to have put together an excellent blog and I look forward to following his decision to purchase or not purchase the robot.

Subscribe to individual entries to keep track of what others say

I am very pleased to announce a very nice upgrade to the robotic surgery blog.

I have installed a plugin that allows users who make comments to blog entries to subscribe to that entry.

You can then receive an email if someone else makes additional comments.
You will get an email to confirm that you did indeed, sign up for the entry and can easily cancel the subscription to the entry with each reminder.

Thanks to gruntdoc for introducing me to this feature from everitz.

Uro Stream- Urology Blog by keagirl

Scouting the blog world, I found an excellent blog from another urologist:
Uro Stream: RANDOM THOUGHTS AND RANTS FROM YOUR FRIENDLY UROLOGIST

keagirl

  • Occupation: Urologist
  • Location: A Big City, USA

About Me

I’m convinced that I am a frustrated veterinarian at heart. However, my
unfortunate allergies to most rodents, felines and equines led me to the
wonderful world of human medicine and the ever humorous field of urology.

Grand Rounds for 1/24/2006

Kevin, MD hosts this weeks grand rounds:

Welcome to Grand Rounds, the weekly best the medical blogosphere has to offer, and a hello to all the new readers from WebMD. I’m honored to be hosting for the third time – it has come a long way since Kevin, M.D. last hosted way back in 2004.

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