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.
I recently had an encounter with United Healthcare that initially resulted in a denial of a request to treat one of their patients with UPJ stenosis (partial obstruction of the drainage leading from the kidney to the bladder) with a robotic repair of the condition. The denial was initially based on the perception that such surgery was “experimental” and not a generally accepted form of treatment. After nearly two months of back and forth, I have approval to do the procedure and I believe I have convinced United Health to accept the procedure generally for all its subscribers. I have posted below several references to articles that I forwarded to the medical director in the course of our discussions. Most pyeloplasties are done in children and you can see that the articles reflect that, although my patient was an adult. Perhaps they will be of help to someone else in a similar situation.
At the Pacific Rim Robotics Conference last month there was a session on robotic pyeloplasty. It was held on Saturday afternoon, the last day of the conference, and featured a lecture by Dr. Elspeth McDougall and a live broadcast of the operation from UC Irvine performed by Dr. Ralph Clayman. Dr. McDougall described the operation as they perform it at UCI and then showed their results in about a half dozen cases, including a bilateral pyeloplasty in a horseshoe kidney. The outcomes were at least as good as with open, laparoscopic or endoscopic pyeloplasty techniques. The steps that she described in her lecture were those that we would see Dr. Clayman follow in the live demo that was presented imediately after her talk. I was interested because I have done about a half dozen or more myself and my partner has done several as well.