Laser TURP

By Richard A. Santucci, MD, FACS

The prostate is one of the main organs of the male reproductive system. For many men in their 50s, the prostate begins to grow, and it may continue to grow for the rest of their lives.

As the prostate grows, it puts pressure on the urethra—the tube that carries urine and semen out of the body. This increasing pressure on the urethra can lead to bothersome urinary symptoms and future problems such as surgery on your prostate.

An enlarging prostate is common…

The prostate continues to increase in size throughout life by about 2% a year. That means that many older men have some enlargement of the prostate, and many of these men have urinary difficulties from this prostate enlargement. Medical therapy is available, but surgical therapy is still considered the “gold standard.”

Medicine can help some men with prostate problems. However, some men do not tolerate medication, or they do not work, or the patients are simply tired of the idea of taking 1-2 pills a day for the rest of their life. Those men with really severe prostate enlargement causing a complete inability to urinate might not even be good candidates for medical therapy and will need surgery.

In these cases, surgical therapy to decrease the size of the prostate is needed. There are many, many types of treatments, but the most common is an old fashioned operation called a “TURP” or TransUrethral Resection of Prostate”. The blocking part of the prostate is shaved out with an electrically charged coil, through a telescope which is placed in the urethra.

This procedure works very well, but there have been many, many updates and improvements in this operation, and these improved procedures are NOT performed at every medical center. Currently, standard TURP is considered to be a “first generation” procedure.

A “second generation” improvement is the GYRUS bipolar TURP which results in less bleeding and earlier catheter removal.

A “third generation” improvement is the laser TURP such as the PVP or “Greenlight” laser TURP, but new and improved advanced lasers represent the cutting edge, most effective treatment for enlarged prostate.

Laser TURP, a 4th generation improvement for the 21st Century…

The most modern and improved form of TURP is to use a laser to remove the blocking portion of the prostate. This procedure has many advantages: Bleeding is minimized, and the time that a urinary catheter must be left in is decreased.

This procedure can be performed safely on those who are taking blood thinners such as aspirin, Plavix, or even coumadin (warfarin) without concern for bleeding. The most modern form of laser available today is the “Greenlight HPS” (High Performance System) which works even more quickly and effectively than older “Greenlight” lasers. This laser is used because it is FOUR GENERATIONS more advanced than the standard TURP still performed at many hospitals – a procedure that was developed almost 100 years ago.

It is important for a patient to discuss prostate surgery options with their physician to determine which procedure is right for them. Ultimately, the end result is to have a successful outcome that represents the physician’s goal, and the patients’ needs.

Dr. Santucci is Chief of Urology at DMC Detroit Receiving Hospital and an associate professor at Wayne State University School of Medicine.

The Future of Prostate Surgery is Here… in SE Michigan!

With Mani Menon, MD

Robots. You hear that word and you may think of R2-D2 from Star Wars, or maybe you think of the robot from “The Day the Earth Stood Still”. Maybe, if you work on the line for the Big Three, you actually think of the big machines that help put the cars together. Most people wouldn’t think about robots in medicine unless it was in some sci-fi show. But, robots are here. And, they are helping patients right here in Southeast Michigan.

Unfortunately, prostate cancer is something that many men will face in their lifetime. In the past, men had only a few options when it came to treating the disease, especially if discovered in its later stages.

These options included chemotherapy, radiation therapy and surgical intervention. Each has their drawbacks, but with the advent of robotic assisted laparoscopic prostatectomy surgery, a procedure that was invented and perfected here in Detroit, the surgical route is now a better option than it has ever been.

Dr. Mani Menon and his team at the Vattikuti Urological Institute at Henry Ford Hospital developed the surgical technique to utilize the daVinci™ Surgical System on prostate cancer. The procedure is aptly named the “Vattikuti Institute Prostatectomy” or VIP.

The VIP is the first minimally invasive system used for a major cancer. It has been used to perform almost 3,000 procedures since it’s development in 2001 and is the foundation for the technique now performed all around the world.

“The daVinci Robotic Surgical System has brought the computer age to the operating room,” says Dr. Menon, describing this new system’s impact on the future of surgical medicine. “Patients can now expect faster recovery times, with very little blood loss, and less adverse events than in the past.”

Historically, surgical intervention for prostate cancer was done through a large incision in the abdomen (large enough to allow the surgeon’s hands access to the prostate) and left many men with complications such as incontinence and impotence. The daVinci system utilizes small cameras and pencil thin tools to minimize trauma and speed up recovery times.

When a patient undergoes the robotic assisted laparoscopic prostatectomy surgery, they are prepped and the robot is moved in to place. The robot’s four arms and their associated devices are inserted into the body through much smaller incisions than were previously required.

While the surgical team monitors the patient, the surgeon is actually several yards away working at a special station. This station has a binocular-like viewing port to allow the surgeon a 3D, high definition view of the surgical site. The surgeon’s hands and fingers are placed into the control devices allowing him to make very precise movements that are then carried out by the robot.

The robot’s computer system performs thousands of safety checks per second and also corrects for any tremors or unwanted movement of the surgeon’s hands. It is this new precision that makes it possible to spare the vital nerves to the area and minimize the incidence of incontinence and impotence.

According to Dr. Menon, “The surgeon and the entire team work in a virtual 3D world and are able to plot out their actions and review them prior to implementing them.” This virtual world also makes the system ideal for teaching the procedure to future surgeons.

“The increased cost of the procedure is transparent to the patient. It ends up costing the hospital about $2000 more than the traditional procedure, but this (cost) is offset through increased volume and efficiency,” said Dr. Menon.

Men have traveled from over 22 countries and all 50 states to have the procedure done here in Michigan. One case involved a man stationed at the McMurdo station in Antarctica who flew to Detroit to have his surgery and returned to work in Antarctica shortly thereafter.

This high-tech procedure is revolutionizing the way physicians can treat patients. If you are facing a prostatectomy now, or in the future, you should be glad to know that several of these $1.5 million robots, and the team that developed the surgery, are right here in your backyard.

Dr. Menon, M.D., is chairman of the Department of Urology at the Henry Ford Health System, the Rajendra and Padma Vattikuti Distinguished Chair in Oncology and Director of the Vattikuti Urology Institute. Dr. Menon is tenured professor of urology at Case Western Reserve University School of Medicine, Cleveland. He graduated from JIMPER Pondicherry and did his residency in Urology at the Brady Urological Institute at John Hopkins, Baltimore.