NEW YORK (August 5, 2010) -- One of the challenges of prostate cancer surgery is removing the cancer-affected gland without side effects. The procedure is estimated to cause long-term sexual dysfunction in half of men.
Now, new published research by urologic surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center presents evidence that a new laser technology used with robotic prostate cancer surgery may reduce the risk of damaging the crucial nerves necessary for erections and urinary continence.
Published in the July online issue of the Journal of Endourology, the pilot study is the first to evaluate the CO2 laser for prostate cancer. The research was also presented recently at the American Urological Association annual meeting in San Francisco.
"The precision of movement available through robotic surgery is already helping reduce the risk of sexual side effects, and the early evidence is that CO2 lasers will help us be even more accurate -- especially when preserving the sensitive nerve areas necessary for sexual function and urinary continence," says Dr. Ketan Badani, director of robotic urologic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of urology at Columbia University College of Physicians and Surgeons.
CO2 lasers are widely used to treat cancer in the head and neck. A new, flexible, fiber-based delivery system is now making the treatment approach possible with robotic prostate cancer surgery.
In the procedure, Dr. Badani uses the robotic instrumentation to remove the patient's prostate. This process is aided by the laser, which is used to dissect the plane between the nerves and the prostate, freeing the nerves and preserving them.
"Traditionally, we cut, clip or cauterize the tissue around the prostate nerves. However, these techniques can cause irreversible damage due to traction or heat injury," explains Dr. Badani. "The CO2 laser may reduce this risk because it is low-heat and doesn't require much manipulation of the nerves."
The new study describes the use of the laser in 10 cases. It reports that the technology is easy to manipulate and very accurate. Patients experienced a return of urinary continence better than the norm, something the researchers found "extremely encouraging." Future research will determine if the technology can improve outcomes with regard to the ability of men to sustain an erection, and its long-term ability to prevent cancer recurrence.
The laser technology, known as BeamPath, was provided by OmniGuide of Cambridge, Mass. OmniGuide BeamPath CO2 laser fibers are cleared for use by the FDA across a variety of open, endoscopic and laparoscopic soft-tissue cutting applications, including urology.
The paper's first author is Dr. Philippa J. Cheetham, postdoctoral fellow at Columbia University Medical Center. Co-authors include Dr. Jaime M. Landman, associate professor of urology at Columbia University College of Physicians and Surgeons and a urologist at NewYork-Presbyterian/Columbia; Matthew D. Truesdale, a medical student at Columbia University College of Physicians and Surgeons; and Daniel J. Lee, postdoctoral fellow at Columbia University Medical Center.
According to the American Cancer Society, prostate cancer is the second most common type of cancer found in American men, and the second leading cause of cancer death in men. In 2009, it is estimated that there were 192,280 new cases of prostate cancer and 27,360 deaths from prostate cancer in the United States alone.
NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,353 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including more than 220,000 visits to its emergency departments -- more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the most comprehensive medical research enterprise in New York City and State and one of the largest in the United States. Columbia University Medical Center is affiliated with NewYork-Presbyterian Hospital, the nation's largest not-for-profit, non-sectarian hospital provider. For more information, please visit www.cumc.columbia.edu.
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Journal of Endourology