THCB

Categories

Above the Fold

Op-Ed: Robot-assisted Surgery – The Leading Treatment for Prostate Cancer

• 7

By DR. JAMES PORTER

da Vinci

Prostate cancer surgeons around the world are using surgical robots to assist in the most delicate operative procedures. Across the country, nearly 1,000 of these robots have entered hospital operating rooms, including our institution: Swedish Medical Center in Seattle, Wash.

These minimally invasive devices, called daVinci surgical robots, offer patients substantially less pain, short recovery time and quicker return to normal activities than traditional open surgery. And because of this, the da Vinci and I have done more than 900 procedures together.

The da Vinci robot assists me during surgery by taking my movements and making them better: more precision, greater freedom of movement and no surgical tremor. These robots offer unmatched surgical precision – meaning my hand cannot compare to the dexterity of the robotic arms. We simply cannot turn our hands 540 degrees.  Da Vinci has 4 robotic arms, which I control at all times at the surgeon’s console. I look through a 3-D viewfinder at the console, which gives me visual depth, and a magnified view 10 to 15 times closer than human vision allows.  This magnified view gives me more precision as well.  Better visibility, better instrument movement means better surgery.

Through my years using da Vinci surgical technology, I know that it offers several advantages over conventional open surgery.  These include less pain, faster recovery, and less blood loss which means reduced need for blood transfusions. Because the surgery is performed through small incisions there is less internal scarring and less risk of bowel adhesions.

Most importantly, with regard to prostate surgery, using the robot has demonstrated improved outcomes over open prostatectomy.  In my experience this has resulted in less urinary incontinence, less erectile dysfunction, and excellent cancer control.

Coincidentally, I was diagnosed with prostate cancer in April 2006, and like all of my patients, the news was devastating. I looked at all the available treatment options and decided to pursue the robotic surgery over radiation therapy or open surgery.  For me, radiation was a shotgun approach and the nerves that control sexual function are potentially at risk from the radiation.  Having the prostate removed gave me information about the amount of cancer and whether it was contained inside the prostate.  This is important in predicting the future behavior of the cancer and I would not get this critical information if I radiated the prostate.

Another important factor in my decision is that once radiation is performed, and if the cancer were to come back, surgery is not an option after radiation due to the high complication rate and difficulty created by the effects of radiation on the tissues. Tissue just does not heal well after it has been radiated.  Conversely, if I had surgery first, and the cancer came back, then radiation was still an option. Essentially, I would be eliminating one treatment option if I had chosen radiation first.

Robot-assisted surgery allowed me to return to my normal activities quickly and this was important for my patients and practice. Through five small incisions about a half-inch in length, the robotic instruments and cameras are inserted into the patient (in this case, me). Compared to the open surgical incision, these incisions are significantly smaller and for many patients this alone is reason enough to consider the procedure over traditional open surgery. I was at home in just one day and at work within two weeks.

The typical prostate surgery patient after a more traditional operation is in the hospital two to three days and is recovering for four to six weeks.  Almost all my patients have gone home the day following surgery, and most are back to normal activities by two weeks.  90 percent of my patients don’t take narcotic pain medication once they leave the hospital.

Today, prostate cancer affects 1 in 6 men in America. A non-smoking man, for example, is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers combined.

Every man is at risk for prostate cancer. While the causes for prostate cancer are largely unknown, one thing is certain – the chance of developing prostate cancer increases in men over 50. While age is clearly associated, I am seeing more and more men with prostate cancer under the age of 50 and even under 40.  Close relatives of men with prostate cancer are also more likely to be affected.

This means that annually more than 192,000 men will be diagnosed with prostate cancer, and more than 27,000 men will die from the disease.  This ranks prostate cancer as the second leading cause of cancer death in men just behind lung cancer.

However, the future is no longer as bleak as it once was. If caught early, prostate cancer is a treatable disease, which many men have survived. Today about 85 percent of prostate cancer surgery is performed using the da Vinci robot – it has become the norm for the surgical removal of the prostate.

As a surgeon, I’m acutely aware that the location of the prostate gland deep inside the pelvis makes these surgeries a complex and delicate procedure. Removing the prostate is just part of the procedure.  Preserving the integrity of the tissues surrounding the prostate is essential to maintain urinary control and sexual function. That is why the benefits of robot-assisted surgery can be so critical.

Many men elect a robot-assisted prostatectomy because it often provides the fastest return to normal daily activities. My experience as both a surgeon and as a patient is proof. If you are diagnosed with prostate cancer, be sure to make an informed decision about your course of treatment by doing your homework and researching the best approaches available, including robot-assisted surgery.

Dr. James Porter is director of surgical robotics at Swedish Medical Center in Seattle, Wash. and a prostate cancer survivor. Under his leadership, Swedish is one of the first medical centers in the Pacific Northwest to perform robot-assisted surgery. Swedish’s robot-assisted surgical program was first established at Swedish in 2005. Since then, Swedish-affiliated surgeons have performed more than 2,000 procedures using the da Vinci Surgical System, more than any other robot-assisted surgical program in the Pacific Northwest. Dr. Porter is the first medical professional in the country to perform a retroperineral robot-assisted partial nephrectomy using the da Vinci robot (removal of a kidney tumor). Dr. Porter trains surgeons from around the globe how to use the da Vinci robot.

The Big Day for Health 2.0

• 2

By Matthew Holt

Yes, today is the big day for Health 2.0 or rather the first of two huge days. In less than 7 hours Indu and I will be stepping onto the stage and six months of work, rehearsals and excitement come to a climax. Many thanks in advance to all the speakers, sponsors, staff, exhibitors, volunteers and members of the Health 2.0 community for coming. We’re ready (or close as we’ll ever be!)

I can’t hope to capture all that’s happening, but here’s two big pieces of news. Myca just received an investment from Sandbox, the Blues venture fund. You can hear an interview I did with Nat Findlay, Myca CEO from a few days back here. You can see Myca both on the Clinical Groupware panel on Day 1 (today!) and in a sponsored Deep Dive on day 2.

And Keas, Adam Bosworth’s company, is formally launching on Day 2 and gets its own article in the NY Times today. You’ll be hearing more about this, and platforms and unplatforms throughout the conference!

Finally, THCB & Health 2.0 has its own little news. JD Kleinke (the Arriana Huffington of health care!) is emerging from a long period of seclusion and both pens his first article as a a THCB contributor today, but is also a very late addition to the “Can Health 2.0 Make Health Care More Affordable” panel at Health 2.0 today!

Pop the Cost Bubble: Unallot Medicare

• 8

Victor Sandler

By VICTOR SANDLER

Here’s a dirty little secret: Cutting health care costs is not that difficult, nor will it harm patients. That’s because it only involves giving up unnecessary medical care—tests and treatments patients may want but really don’t need because they don’t benefit their health.

How is this supposed to happen? In Minnesota we call it “unallotment.” When the state had to reconcile a projected multibillion dollar budget deficit this year, and the Republican governor and Democratic lawmakers couldn’t agree on how to do it, the governor simply “unalloted” billions of dollars of planned expenditures.

Medicare should do the same. All Congress has to do is pass the MedPAC Reform Act of 2009 (SF 1110) and give it teeth. We can then unallot the 30 percent of Medicare expenses that most health care experts believe are unnecessary. That’s the 30 percent that goes for tests, drugs, and devices that don’t have any proven benefit but sell like hotcakes anyway.

When Gov. Tim Pawlenty decided to cut medical expenditures during the unallotment process, he took no prisoners. More than 30,000 indigent adults will simply have their medical insurance eliminated starting next March. Medicare would take a higher road, eliminating unnecessary care and costs, not “unnecessary” people.Continue reading…

Let’s Not Lose Sight of the Goals

• 10

By BILL KRAMER

Picture 4

I love Daniel Schorr.  I’ve never met him in person, but I love his voice and his insights about politics on NPR’s Weekend Edition.  But this morning I was disappointed.  After listening to his comments on the Olympics and Iran, I looked forward with anticipation to his thoughts about the Senate Finance Committee’s accomplishments earlier this week on health reform legislation.  When asked whether a “real health care bill” is likely to pass later this year, he said, “Well, it begins to look more [likely] . . . that there will be a bill.  The question is not whether there will be a bill . . . but what will be left in the bill, because so many things have been taken out.”  I could almost hear him sigh.  He went on to talk about the fact that the public option is not a part of the Senate Finance bill, although it might be restored in full or part (through a trigger mechanism or health cooperatives) as the bill moves through Congress. Let’s step back for a minute.  (This is what I usually rely on Schorr to do for us.)  Where were we a year ago?  Although advocates of health reform were encouraged that the health care crisis was getting a lot of attention in the Presidential election campaign, the outlook was not rosy. Obama and McCain were neck and neck, and McCain’s reform proposal was so weak as to be laughable.  The pundits and pollsters were predicting that the Democrats would get about 56 seats in the Senate – not enough to overcome a filibuster.  And there was serious concern that even if Obama were elected, health reform would be crowded out by other major crises – the threat of a serious economic depression, the banking collapse, Iraq/Afghanistan/Iran, energy and global climate change, and who knows what else.  In October 2008, the likelihood of serious comprehensive health reform was probably about 25%.

Continue reading…

Olberman, hysterical hypocrisy expose

• 11

By Matthew Holt

A really fun piece from Keith Olbermann as he shows how the entire Gang of Six and more voted for fully socialized flood insurance and yet seem to have a problem with an independent government run public option.  

Of course, now that a bill has finally left Baucus committee, our meandering towards a relatively inconsequential tinkering at the edges of the health insurance market is a little further down the path. But can we somehow arrange it that the bozos at the NY Times (yes I’m talking about Robert Pear and David Herzenhorn) please stop saying things this dumb:

the Democrats are trying to restructure one-sixth of the economy, writing a bill that will affect almost every American, every business and every doctor and hospital in the country.

The level of exaggeration in that statement is simply unworthy of the paper of record. Would that it were true.

JSK (national treasure) on data liquidity, and how it fits into Health 2.0

• 2

By Matthew Holt

Given that she taught me most of what I know about health IT I don’t know why I ever need reminding about how great Jane Sarasohn-Kahn is at keeping her finger on the pulse of health care, and how consistently good is her one daily post on Health Populi.

Yesterday was no different. She gave a great overview of a new PWC study on data liquidity. You’re going to hear lots from me and others in the coming days about data liquidity, substitutability, intermingling of applications, and unplatforms. But what’s happening on the edges of health care IT in the Health 2.0 movement is a combination of tools, content and transaction data beginning to flow between applications. More and more this is both enabling better management of the consumer (and clinicians) workflow experience and better ways to aggregate these new data sources for clinical decisions and research.

On day Two of the Health 2.0 Conference next week we’ll be showing this both in our panel on Data Drives Decisions, but also on the Tools panel which will feature a series of inter-operable applications sharing data. And we’ll also be showing the big players (Google, Microsoft & WebMD) as they move their offerings to a world where other service providers can use their platform.

Truly exciting times, but Jane points out that there are lots of barriers. She calls the PWC report

a sober analysis of what stands between transactions and raw data, and the ultimate goal of using that information: clinical transformation that benefits people.

And those barriers all center around the workflow, payment structure and institutional inertia of our current health care establishment.

 the health industry en masse needs to shift the focus of data from transactions to quality and outcomes. This will require – surprise, surprise – incentives to, as PwC puts it, “induce all stakeholders to collect, report and use the data.”

Two big deals in Health 2.0

By Matthew Holt

John Halamka writes about the small but important meeting this week at Harvard Medical School hosted by Zak Kohane and Ken Mandl. Because of the impending arrival of about 1,000 of my best friends next week at Health 2.0, I couldn’t go to that meeting. But it may be very important in putting the “cats and dogs” together to think about ways for new platforms with players like Halamka and David Kibbe (who have not been on the same side of these issues) both taking part.

Meanwhile, yesterday Microsoft released My Health Info. I got a quick preview and it’s essentially a layer over HealthVault that allows both Microsoft and others to build widgets that can be arranged on sites like MSN Health (and presumably many more to come) which directly connect with the individual’s data in HealthVault. It essentially is the cool user interface that HealthVault has been missing and it’s more evidence of Microsoft’s serious intentions in consumer health care.

If you’re at Health 2.0 next week you’ll see Microsoft’s My Health Info and hear much, much more about what David Kibbe is calling Clinical Groupware, and also many demonstrations about we’re starting to call “unplatforms”.

While health reform is arguing about multiple amendments in Baucus’ committee and making some of us despair, the tech world is showing some real promise.

Money-Driven Medicine film now downloadable

• 3

By Matthew Holt

If you want to watch the documentary Money Driven Medicine based on Maggie Mahar’s book, it’s now available for free download at moneydrivenmedicine.org (the DVD is also available for purchase). The free download is part of an ongoing “Watch-In! For America’s Health” — a national viewing party organized in conjunction with the Consumers Union.

Carrot or Stick? Should Patient Decision Aids Be Rewarded or Required?

• 6

By DON KEMPER

Don kemper

  1. Should we incent or require providers to prescribe patient decision aids?
  2. Should we incent or require consumers to use patient decision aids?

Over-treatment is the most celebrated cause of runaway health care costs, but we shouldn’t blame the doctors. The fee-for-service system sets them up for over-treatment. First, they have been taught that offering all possible cures to every patient is good medicine. Second, malpractice law pushes them toward offering more testing and services, not less. And third, they generally get paid more when they do more. It’s hard to buck a triple-threat system like that without a little help from the patient. Fortunately, it’s not that hard for patients to provide that difference.Continue reading…

assetto corsa mods