Robotic perineal prostatectomy performed in the UK

The first robotic perineal prostatectomy performed in the UK
 
The robotic prostatectomy continues to evolve with Mr Christopher Ogden and his team at The Royal Marsden Hospital who performed the first robotic assisted perineal prostatectomy in the UK. This approach was first pioneered by a Urological Professor from Cleveland, USA, who visited the team at The Royal Marsden to help and share his expertise.

The successful operation was performed on a 65 year old patient with prostate cancer, Gleason 3+4 in 11/28 cores. During the operation he experienced minimal bleeding and no bowel handling. He was fit for discharged the following day with minimal pain and two weeks later he had a successful trial without catheter. The histopathology confirmed the cancer was organ confined and with negative surgical margins – a very successful operation.

Compared with the more traditional retropubic approach, the perineal prostatectomy will allow patients who have had extensive abdominal surgery to undergo the operation as it avoids the abdomen altogether. It also allows the surgeon to maximise the urethral length which aids post prostatectomy continence.
 
Perineal surgery was previously suitable for the open approach only but following the success of this robotic perineal prostatectomy we will hopefully see a revival using the robot and our future surgeons will be trained in this approach too.
 
Please click here for the full article which appeared in Urology News on 1st January 2019.



“There are no robots in that kitchen”… “Maybe one day.”

The Great British Menu 2018 is almost certainly not the most obvious place to look for a urologist specialising in robotic surgery but, despite his huge workload Chris Ogden was able to make an appearance on the judges panel on the BBC programme the Great British Menu.

Programme Name: Great British Menu - TX: n/a - Episode: Finals Week - Fish Course (No. Finals Week - Fish Course) - Picture Shows: Oliver Peyton, Chris Ogden, Andi Oliver, Matthew Fort - (C) Optomen TV - Photographer: Andrew Hayes-Watkins - © BBC

Raising awareness for prostate cancer and robotic surgery, Chris Ogden was invited as a guest judge in this year’s fish final. The winners of this year’s competition receive the honour of cooking for the heroes of the NHS at the banquet.

Great British Menu 2018 - Act Fast & Watch Below

The episode is available to watch on BBC iPlayer until mid-November 

A revolutionary pioneer of robotic surgery specialising in prostate cancer and the     the most prolific prostate robotic surgeon at London’s Royal Marsden”, Chris Ogden discussed the evolvement of prostate cancer surgery and in particular the use of the da Vinci robotic device “which was initially researched and pioneered by NASA and enhances the use of key hole instruments which are manipulated remotely through a console which the surgeon sits [at] to carry out the procedure.”

He continues on how this safe, successful surgery has “empowered [men] to be diagnosed and treated early and therefore the outcomes are much better for men.”


For more information on robotic surgery and prostate cancer please visit our website www.roboticprostatesurgery.co.uk

great british menu 2018

Programme Name: Great British Menu - TX: n/a - Episode: Finals Week - Fish Course (No. Finals Week - Fish Course) - Picture Shows: Chris Ogden, Oliver Peyton, Andi Oliver, Matthew Fort - (C) Optomen TV - Photographer: Andrew Hayes-Watkins - © BBC

"It depends how special the chef is"

Ellis Barrie, representing the North West, scored a perfect 4 "tens". Each of the four judges found his food to be faultless and clearly worthy of inclusion in the banquet.

Before the dish was served, Matthew Fort posed a question about Ellis's dish:

"Chris, is mackerel special enough for a banquet?"  

Chris's response "It depends how special the chef is!" turned out to be a great prophecy.

Ellis was duly selected as the winner of the fish course final. The quality of his cooking was outstanding but most importantly the way his "Bun In The Oven" met the brief of the competition was also greatly admired.

Bun In The Oven

Steamed squid ink bun, torched mackerel, dill emulsion, shallot variations and cashew crunch served with mackerel tartare and kohlrabi tagliatelle, buttermilk and horseradish dressing, dill oil

In summary although the dish sounds simple enough take a look at the full ingredients and method here to understand how complex this creation really is.

Chris Ogden at the Great British Menu 2018

Programme Name: Great British Menu - TX: n/a - Episode: Finals Week - Fish Course (No. Finals Week - Fish Course) - Picture Shows: Chris Ogden - (C) Optomen TV - Photographer: Andrew Hayes-Watkins - © BBC

Symptoms of Prostate Cancer Worrying You?

There are many potential symptoms of prostate cancer. You should be aware of these as early intervention can radically reduce the longer term risks and in many cases prevent you from worrying unnecessarily.

If you are experiencing any of the following signs you don't need to be alarmed but you most certainly should see you GP as soon as possible to investigate the cause

10 Symptoms of Prostate Cancer

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    Difficulty starting or stopping the urine flow
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    Urgency of needing to urinate
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    Frequent need to urinate, particularly at night
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    Loss of bladder control
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    Weak flow
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    Pain or burning sensation during urination
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    Difficulty having an erection
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    Pain at ejaculation
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    Blood in urine or semen

You can find more details on the Cancer Research website

Your GP will carry out some basic tests, depending on your own personal symptoms, which will include a blood test to check your PSA level and potentially a referral to a specialist urologist for more detailed investigation.

In the worst case, should cancer be diagnosed, there are now even greater chances of successful treatment with the advent of more advanced medical technology.

Symptoms of Prostate Cancer - Could Be Non Cancerous

Prostate cancer is often slow-growing and symptoms may not be evident for many years. Generally the signs only occur when the cancer is large enough to put pressure on the urethra. However, the good news is that the prostate can also become enlarged due to a non-cancerous condition called benign prostatic hyperplasia (BPH).

If you are concerned about any of these signs, or you know a man who is, seek guidance from a GP as soon as possible.

Please help spread the work and share this post via one of the links below.

Erectile Dysfunction Following Radical Robotic Prostatectomy: 

 

Erectile dysfunction following radical robotic prostatectomy is a significant side effect. Impairment of erections is due to the unavoidable nerve damage (20-50% of men with good pre-operative sexual function) however, with the introduction of nerve-sparing which is the technique used at the time of surgery, most men should expect to regain erectile function within the first two years following surgery.

 

The nerves and blood vessels which control the physical part of an erection are known to be very delicate and therefore any disruption to the area will naturally result in a change in erectile function.

 

Where nerve-sparing is performed at the time of surgery, you will be offered safe therapies that will not hamper the likely recovery of spontaneous erectile function. Phosphodiesterase 5 (PDE5) inhibitors are often used to support erectile function recovery, your Consultant or Nurse Specialist will be there to help you and instruct you on the use of these and discuss further therapies available to you. Please see below for more information:

 

Treatments Available For Post-Prostatectomy Erectile Dysfunction

 

PDE 5 Inhibitors (Phosphodiesterase 5) – Cialis, Viagra, Levitra

  • Dilates the blood vessels of the penis
  • Allows relaxation of musculature
  • Requires sexual stimulation
  • Safe in cardiac patients, but care needed in assessment to ensure not with nitrates and caution with alpha blockers

 

How to take them:

  • Take at lease 30 minutes before sexual activity (45 mins for Viagra).
  • Avoid heavy meals 2 hours prior to taking Viagra (not a problem with Cialis).
  • Will require sexual stimulation / intimacy to acquire an erection.
  • May require up to 8 doses to gain optimum effect (on separate days).
  • Don’t give up!

 

Possible Side Effects:

  • Headache
  • Vomiting
  • Indigestion
  • Flushing
  • Nasal Congestion
  • Dizziness
  • Visual Disturbances
  • Back Pain – Cialis

NB: Side effects diminish with repeated use.

 

Vacuum Constriction Device

  • Blood drawn into the penis using a vacuum device and constriction ring
  • Physiotherapy to penis – Used to increase oxygen to the penile tissue and maintain length and girth
  • Works within 5-6 minutes
  • Effective in patients that cannot have PDE5 inhibitors

 

Advantages:

  • Rapid and effective
  • Suitable for most men
  • Few contraindications

 

Caverject Dual Chamber

The Evoloution of Robotic Surgery

Mr Christopher Ogden, Consultant Urologist, explores the evolution of robots and how surgical robots are used in revolutionary ways in the treatment of prostate cancer including:  da Vinci radical robotic prostatectomy, CyberKnife and High Intensity Focused Ultrasound. CLICK HERE for the full article.

History of the Robot

The robot is a machine capable of carrying out a complex series of actions automatically. The rationale of a surgical robot is to perform remote surgery or telesurgery and to enhance or increase the performance and outcomes of surgery over and above that achieved by the limitations of the human hand. The current explosion of the use of robotic surgical instruments we see today began in the beginning  of the millennium with American military funded research into systems that could be used for remote surgical operations, either a continent away at the front line or remote places, including the space frontier.

Radical Robotic Prostatectomy

Mr Christopher Ogden has the longest and largest series of radical robotic prostatectomy operations performed by any surgeon in the UK, with around 2,000 robotic procedures performed under his care. He is currently part of the first randomised control trial, comparing robotic surgical prostatectomy with the da Vinci robot and the CyberKnife radiotherapy robotic system. This trial is being lead by The Royal Marsden Hospital with 35 patients recruited to date.  Mr Ogden also presented one of world’s first comparison studies between whole gland HIFU and da Vinci robotic prostatectomy for the treatment of prostate cancer. He has completed multicentre trials, including the Index Study which looks at the clinical outcome of focally treated prostate cancer and is designed to assess its role in comparison to whole gland treatment.

For more information on the evolution of robots and in particular, the use of surgical robots in the treatment of prostate cancer, please CLICK HERE for Mr Christopher Ogden’s article in Hospital Healthcare Europe.

Medical robots – can it really be true

The Times reported on 5th May 2016 that medical robots (or a fully automated surgeon) successfully stitched up four Yorkshire piglets after an operation.

 

Medical robots - Times May 2016 - Robotic surgeon

CLICK HERE for the full report.

Device to be used on people

Whilst the paediatric surgeon, Peter Kim, who led the work contends that it is only a matter of time before the device will be ready to be used on people, British expert, Christopher Ogden feels that it is unlikely the machine will be able to cope with anything more than the most routine procedures.

Robotic surgery success

Christopher Ogden, who has carried out more than 2000 prostate operations at the Royal Marsden hospital in London is concerned that the robot would struggle with the differences between one human body to the next and consequently it is unlikely that a surgeon would ever be fully replaced.