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| SLIDES
& TRANSCRIPTS
Saturday,
December 14, 2002
Prostate
Cancer III: Laparoscopic Radical Prostatectomy: Are We Making Progress?
Leonard
Gomella, M.D. |
| Slide
1: |
 By
way of introduction, the title of this session is Laparoscopic
Radical Prostatectomy: Are We Making Progress? What I wanted to
do is just about a two or three minute overview of exactly why
we are all here today.
TOP
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| Slide
2: |
|  Endourology,
as everyone in this room is aware, which you may want to call the
minimally invasive urological oncology phase, or as some of the
endourologists call it, the endo-oncology phase, where increasingly
minimally invasive approaches, particularly using laparoscopic intervention
are being used to treat a traditionally open series of surgical
procedures.
TOP |
| Slide
3: |
|  I
think it's important to look at where we have been, to understand
where we are going. And I put together a laparoscopy and radical
prostatectomy timeline here, showing that the first radical prostatectomy
was actually described in 1901, the same year that the concept of
coelioscopy, which has now come to be known as laparoscopy, was
introduced.
In 1904, Dr.
Young presented the first series of radical prostatectomies. And
it was pretty quiet in this particular area until 1976, when Cortese
described the first urologic application of laparoscopy, and that
was in the study of the patient with a cryptorchid testicle.
In 1983, Dr.
Walsh brought forward the pioneering work with nerve sparing radical
prostatectomy. But it was in 1990 that I think most of us consider
the modern era of laparoscopy arrived with the introduction of the
laparoscopic pelvic lymph node dissection, and the laparoscopy nephrectomy.
It was actually
in 1991, that Dr. Bill Schuessler and a team that included Lou Kavoussi
attempted the first laparoscopic radical prostatectomy. And actually,
in 1997, they published their initial series of nine patients on
the laparoscopic radical prostatectomy.
In the mid-1990s,
a whole bunch of investigators that everyone has become familiar
with now, Dr. Vallencien, Dr. Guillonneau and Dr. Abbou, brought
us into the modern era of the laparoscopic radical prostatectomy.
TOP |
| Slide
4: |
|  But
for all the wondrous enthusiasm a lot of people have about the laparoscopic
prostatectomy, there are some concerns about some of the technical
challenges, and we hope to address some of those today in this presentation.
TOP |
| Slide
5: |
|  Some
of the theoretical benefits of the lap prostate are less pain, shorter
hospital stay, more rapid return to activities, improved visualization
of various structures, less blood loss. And it is certainly a high
profile procedure. It is out there. Patients want this. They want
the robotically performed radical prostatectomy.
But we do have
some concerns in the field. We have concerns about the learning
curve. We have concerns about the cost of equipment and about no
long-term data to compare the laparoscopic radical prostatectomy.
Relatively few centers in the US are now able to offer these procedures.
Who is doing the radicals? Is it oncologists? Is it endourologists?
We're not really clear at this point who has the better skill set
to do that.
Are there real
advantages to this technique? And again, it's high profile, which
is a concern, because a lot of patients now expect that when they
go to the doctor, they are going to be offered the laparoscopic
robotic radical prostatectomy.
TOP |
| Slide
6: |
|  I
just want to finish up with a couple of comments. Bill Schuessler
back in 1997, basically said there is no current advantage to using
the laparoscopic radical prostatectomy over the open surgical approach.
TOP |
| Slide
7: |
| 
However, just a couple of years later, Carl Olsson noted that he
predicted the increasing use of this approach for the management
of organ-confined prostate cancer.
TOP |
| Slide
8: |
|  These
are the key issues I hope we're going to address in the next couple
of minutes -- outcomes; cancer control; what long-term data do we
really have to look at; who should do the procedure; what about
the surgeon's individual expertise and credentialing; where does
robotics fit in? And Dr. Menon is certainly a real expert in that
area. And again, cost issues. Certainly, for those of us that practice
on the East Coast, in particular hot spots like Philadelphia, cost
is a real issue.
TOP |
| Slide
9: |
|  I
just want to leave you with this little thought before we move onto
the rest of the presentation. And that is the cost of technology.
This was a great editorial that appeared back in early this summer
in the New England Journal of Medicine. And basically, when people
criticize things as being too expensive, particularly the HMOs and
other agencies, I think this is a good thing to quote.
"To abandon
the search for improved therapies on the basis of cost would represent
enormous disservice to our patients and would distinguish attempts
to improve patient care from the quest for better automobiles, audio
systems, or computers, or from any other area of human endeavor.
Surely, the search for better therapies is at least as important
as the search for improved audio performance?"
With that brief
introduction, I would like to go ahead and turn the podium over
to Dr. Mani Menon. It's my pleasure again to introduce Dr. Mani
Menon, who is the chief of urology at Henry Ford, and the director
of the Vattikuti Prostate Institute.
Dr. Menon is
going to address the evolving art of laparoscopic radical prostatectomy.
TOP |
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