Dr. Ashdan Tewari, NY Presbyterian Hospital

On Saturday morning a session was devoted to lectures by a leading practitioner of robotic laparascopic surgery, the DaVinci system, and two practitioners of cryosurgery.

Dr. Ashdan Tewari of NY Presbyterian Hospital has been using the DaVinci system to perform minimally invasive RRPs for several years. He reviewed his results to-date.

He said the two major goals of robotic prostatectomies are 1. The Removal of the entire tumor from the body, and 2. having no positive margins following the surgery. He has performed some 1500 procedures using the DaVinci system since it was installed in his hospital.

Dr. Tewari claimed that what he called “incremental nerve sparing” surgery is more feasible with robotics. Of 500 cases he studied, some 95% had “clean” margins. Even with Gleason Scores of 8,9, or 10 he reported “high cancer control”. He also claimed that high BMI (Body Mass Index) individuals didn’t experience any lower levels of margin control.

In the case of nerves that extend into regions of the prostate where tumor is located he reported that such nerves cannot be spared. Experiments to-date with nerve grafting to restore male potency haven’t produced many good results.

Dr. Tewari also indicated that a portion of the nerves may be removed and the nerve reconnected but results of this technique are still not as good as nerve sparing procedures.

He claimed that 80% of men are potential candidates for nerve sparing surgery. As for incontinence, he claimed that only some 4% of men had some degree of “leakage” six months after the surgery.

[Ed. Note: Because robotic surgery is still in its infancy, full studies of side effects vs. those from conventional open RRPs are incomplete. But since the surgeon is working in a relatively blood- free field, his vision and degree of control of his cutting procedures have to be better.

However the fundamental problem remains the same. Slicing and dicing in that region of the male anatomy normally results in some degree of unpleasant side effects. When the urethra is severed from and then reconnected to, the bladder the potential for some degree of incontinence increases markedly.

And the most fear-inducing side effect, impotence following surgery, still occurs. The literature will slowly show more reports of lower and lower incidences of impotence claimed by many practicing surgeons using robotic procedures.

As patients the operative phrase should be “caveat emptor!”. Carefully investigate all potential procedures and choose the one that you feel the most comfortable with. Side effects from prostate treatments are real, rarely reversible, and last a “lifetime”.

And remember also, that once the gland has been removed, any and all subsequent orgasms become “dry”. ]

Intl Prostate Cancer Conference, October 2006, Reston, VA

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