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Encouraging data about a new option for prostatectomy

Since May of 2001—when urologists Eric Wallen, M.D., and John Heaney, M.D., began using laparoscopic technology to perform radical prostatectomies at DHMC—more than 100 patients have chosen the minimally invasive surgery over traditional open surgery. Laparoscopic surgery offers many advantages, including less pain, less bleeding, and a shorter recovery period. Still, the technology is relatively new. Lacking the 20- year track record of standard prostatectomy, laparoscopic surgery needs to prove itself an equally effective treatment, explains Wallen.

An important step in that direction occurred in September, when he and Heaney presented follow-up data, on 62 of their early laparoscopic patients, at a conference of the American Urological Association. As a group, these patients (who'd had a minimum of six months' follow- up) showed results comparable in three key areas to the results for traditional radical prostatectomy: cancer control, urinary control, and erectile function. These findings are extremely encouraging, says Wallen, noting that both urinary and erectile function often take a year or two to return to normal after either type of surgery.

Only about 30 medical centers in the country are currently performing laparoscopic radical prostatectomies, and Dartmouth is among the top 10 in volume; 90% of radical prostatectomies at DHMC are now done laparoscopically.

The technique, Wallen explains, "seeks to replicate all principles of the open surgery." In both types of surgery, the cancerous prostate gland is separated from the bladder and urethra and is removed intact. The essential difference is that open surgery requires a six- to eightinch incision, but laparoscopy is performed using instruments that are inserted through five tiny incisions, each less than half an inch long.

Lens: A lens inserted through an incision at the navel enables the surgical team to see the prostate gland and surrounding tissue, and the instruments go in through four lower incisions. Instead of looking directly into the patient's abdomen, the surgeon sees the operative area on a computer screen.

For someone trained in traditional surgical techniques, where the surgeon's hands are inside the patient's body, learning to perform a laparoscopic radical prostatectomy is no easy task. "The light and magnification help tremendously, but working in two dimensions is tricky at first," says Wallen. He, Heaney, and DHMC surgeon William Laycock, M.D., traveled to Paris to learn the procedure.

DHMC urologist Eric Wallen reported recently on a series of patients who'd had a laparoscopic prostatectomy. Only about 30 medical centers nationally are performing the high-tech procedure, and DHMC is among the top 10 in terms of volume.
Photo: Flying Squirrel Graphics

The difficulty of mastering the laparoscopic technique may account for its availability at relatively few medical facilities in the U.S. But the steep learning curve, Wallen believes, is more than offset by the benefits for patients. "There is no doubt that there's less pain," he says, "and people are back on their feet sooner." Patients are usually discharged from the hospital within a day or two after surgery and can resume normal activities in about three weeks.

Data: Nearly 185,000 American men are affected by prostate cancer each year. So if the follow- up data on patients treated with laparoscopic surgery continues, as expected, to show positive results, no doubt more surgeons will choose to tackle the learning curve.

Catherine Tudish

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