Dr. Antonio Finelli gave a very informative presentation on Laparoscopic Prostatectomy,
Robotic Assisted Prostatectomy and HIFU ( High Intensity Focused Ultrasound ) techniques.
The presentation was integrated with excellent slide and video aids to give the group some
excellent insights into three of the least invasive treatments for Prostate Cancer.

Laparoscopic surgery involves a series of smaller incisions when compared to the more
common Open Radical Prostatectomy. This technique provides several benefits including
reduced blood loss and transfusion rates as well as reduced recuperation times as compared
to open surgery. To perform Laparoscopic Surgery Carbon Dioxide Gas is injected into
the abdominal cavity and telescopic instruments are used to perform the surgery. While earlier
results were inferior to open surgery, experience and techniques have improved to the point
that about 50% of Prostatectomy’s were performed Laparoscopically in the U.S. last year.

One of the early complaints some surgeons had with Laparoscopic Surgery was that it took
longer and required that the surgeon remain in an awkward position for a considerable
length of time. As experience levels increased, the surgical times improved to approach that
of open surgery. This was further enhanced by the introduction of Robotic equipment that
offered surgeons more degrees of freedom, a binocular 3D virtualization of the operating site
and far better ergonomics for the surgeon at the same time during the procedure.

The main downside of Robotic Assisted Surgery is its cost (1.6 Million dollars per unit & high
maintenance costs). Some surgeons also find that there is less feel than with conventional
instruments. Unfortunately, there is currently no solid infrastructure to train surgeons in its use
which further limits the rate at which new surgeons can adopt the new technology.

Dr. Finelli also went on to describe the fairly new treatment known as HIFU. This potentially
offers an even less invasive technique where a rectal probe focuses high intensity ultrasound
waves to destroy the cancerous tissue within the prostate gland. The technique does not require
a General Anesthetic and can be done with the aid of a spinal block. If necessary, the procedure
can easily be repeated.

At present, this technique is generally limited to low risk patients and it is not covered by the
health system so there is a charge for the procedure. Studies have yet to provide long term
comparative results available for Surgery and Radiotherapy. Some of the more common side
effects of the procedure are a sense of urgency and urinary frequency. The use of HIFU will
likely increase as experience and technique improve and long terms results become available.

The question and answer period provided the group with further clarification of
both the benefits and difficulties of introducing these treatments to the general public.