Center for Minimally invasive and Robot Assisted Surgery

07/06/2026

Preparing for a Robot-Assisted Laparoscopic Prostatectomy (RALP) requires meticulous attention to patient positioning and room setup to ensure both surgical precision and patient safety, particularly given the steep Trendelenburg position usually required. innovation

03/06/2026

How did Da Vinci robot Assisted Laparoscopic Prostatectomy revolutionize the management of Prostate cancer?

The introduction of the da Vinci surgical system radically altered the landscape of localized prostate cancer management, effectively transitioning Radical Prostatectomy (RP) from a highly morbid open procedure to a precise, minimally invasive standard of care.
​Prior to the widespread adoption of Robotic-Assisted Laparoscopic Prostatectomy (RALP) in the early 2000s, Open Radical Retropubic Prostatectomy (RRP) dominated. While oncologically effective, it exposed patients to significant blood loss, prolonged hospital stays, and high rates of long-term urinary incontinence and erectile dysfunction. Standard laparoscopy attempted to bridge this gap but was limited by rigid instrumentation and a steep learning curve in the narrow, deep confines of the male pelvis.
​RALP revolutionized this paradigm by solving the inherent mechanical limitations of standard laparoscopy through several key technological innovations.

30/05/2026

How challenging is robot Assisted Laparoscopic Prostatectomy in a patient post multiple prostate biopsies and TURP.

Performing a Robot-Assisted Laparoscopic Prostatectomy (RALP) after both multiple prostate biopsies and a prior Transurethral Resection of the Prostate (TURP) significantly elevates the complexity of the procedure. While an experienced robotic surgeon can certainly navigate it successfully, it is widely regarded as a high-difficulty case that demands meticulous dissection and patience.
​The challenges generally stem from two distinct physiological changes: the dense scarring from repeated needle tracks and the structural alterations from the prior channel TURP.

26/04/2026

The Diversity of "The Three Tiers"
​The subspecialty offers a rare balance of three distinct clinical environments:
​Major Surgery: High-stakes oncological procedures, performed thru robot assisted laparoscopic surgery, such as radical prostatectomy, cystectomies or nephrectomies.
​Microsurgery & Reconstruction: Delicate procedures for male fertility (like vasoepididymostomy) or reconstructive work on the urinary tract.
​Office-Based Procedures: Rapid, high-impact interventions like cystoscopies, biopsies, and endourologic procedures.

01/03/2026

What is an MRI Fusion Prostate Biopsy?

An MRI Fusion Prostate Biopsy is a advanced diagnostic procedure that combines (or "fuses") detailed, pre-recorded MRI images with real-time ultrasound to help a urologist precisely target suspicious areas in the prostate.
​In a traditional biopsy, doctors use only ultrasound, which often cannot see specific tumors. This usually results in a "blind" or systematic sampling of the gland. Fusion technology essentially provides a "GPS" for the biopsy needle.

22/02/2026

When Should men start their PSA examination and how accurate is this biomarker for prostate cancer?

Deciding when to start PSA (Prostate-Specific Antigen) screening is less about a "magic age" and more about your personal risk profile and a conversation with your doctor. Current 2026 guidelines emphasize shared decision-making—meaning you and your physician weigh the benefits of early detection against the risks of "overdiagnosis."

Risk Category Recommended Starting Age
Who is in this group?

Average Risk 50 Men with no family history and a life expectancy of 10+ years.

High Risk 45 African American men or those with a first-degree relative (father/brother) diagnosed before age 65.

Very High Risk 40

​How Accurate is the PSA Test?
​The PSA is a biomarker, not a "cancer test." It measures a protein produced by the prostate; while cancer produces it, so do many other things.
​1. The "Gray Zone" Problem
​A "normal" PSA is traditionally considered below 4.0 ng/mL. However:
​False Positives: About 75% of men with an elevated PSA (between 4 and 10 ng/mL) do not have cancer. Elevation can be caused by an enlarged prostate (BPH), recent exercise, sexual activity, or a simple infection (prostatitis).
​False Negatives: About 15% of men with a "normal" PSA (below 4.0) may actually have prostate cancer upon biopsy.
​2. Sensitivity vs. Specificity
​High Sensitivity: It is very good at "sounding the alarm" if something is wrong.
​Low Specificity: It is not very good at telling us what is wrong. Because it can't distinguish between aggressive cancer and a slow-growing tumor that would never have caused harm, it can lead to "overdiagnosis" and unnecessary biopsies or treatments.
​Modern Refinements
​To make the PSA more accurate, doctors now look at:
​PSA Velocity: How fast the level is rising over time.
​PSA Density: The PSA level relative to the size of your prostate (measured by ultrasound/MRI).
​Free PSA Ratio: A lower percentage of "free" PSA in the blood can sometimes indicate a higher risk of cancer.
​Bottom Line: The PSA test is a valuable "check engine light." It tells you to look under the hood, but it doesn't always mean the engine is failing.
​Would you like me to help you draft a list of specific questions to ask your doctor about your personal risk factors?

17/02/2026

Ej*******on frequency and prostate cancer? How often it should be done.

Research into the connections between sexual activity and prostate cancer....

17/02/2026

How can we cure or prevent prostate cancer?

When it comes to prostate cancer, "cure" and "prevent" are high bars, but the medical community has very clear strategies for risk reduction and successful treatment.
​In 2026, prostate cancer remains the most common cancer in men, yet it has one of the highest survival rates when caught early.
​1. Can it be cured?
​Yes. When prostate cancer is "localized" (contained within the prostate), it is considered highly curable. The primary "curative" treatments include:
​Surgery (Radical Prostatectomy): Often done via robotic assistance to remove the entire prostate. This is generally the gold standard for long-term "cure."
​Radiation Therapy: High-energy rays (external beam) or radioactive seeds (brachytherapy) kill cancer cells.
​Focal Therapies: Emerging treatments like HIFU (High-Intensity Focused Ultrasound) or Cryotherapy (freezing) can destroy small tumors while leaving the rest of the prostate intact.
​Note on "Cure" vs. "Management": For older men or very slow-growing tumors, doctors often use Active Surveillance. This isn't a "cure" but a way to live a full life without the side effects of surgery, monitoring the cancer closely to ensure it never becomes a threat.
​2. Can it be prevented?
​There is no 100% guarantee of prevention (genetics and age play a huge role), but you can significantly lower your risk of aggressive prostate cancer through these lifestyle pillars:
​Diet & Nutrition
​The Lycopene Factor: Cooked tomatoes (sauce, paste) contain lycopene, an antioxidant that has a strong association with lower prostate cancer risk.
​Cruciferous Vegetables: Broccoli, cauliflower, and kale contain compounds that help the body detoxify carcinogens.
​Healthy Fats: Swap red meat and high-fat dairy (linked to higher risk) for fatty fish (omega-3s), nuts, and olive oil.
​Coffee & Green Tea: Some studies suggest that 2–4 cups of coffee or green tea daily may lower the risk of advanced prostate cancer.
​Physical Habits
​Vigorous Exercise: Regular, heart-pumping exercise is one of the most consistent factors in reducing the risk of fatal prostate cancer.
​Maintain a Healthy Weight: Obesity is strongly linked to more aggressive, harder-to-treat forms of the disease.
​Ej*******on Frequency: Some large-scale studies suggest that frequent ej*******on (21+ times per month) may help "flush" the prostate and reduce cancer risk by up to 30%.
​3. The 2026 Screening Guidelines
​Prevention is great, but early detection is the real life-saver. Current 2026 guidelines emphasize:
​Baseline PSA Test: Get a "baseline" blood test between ages 45–50.
​High-Risk Groups: If you are Black or have a father/brother who had prostate cancer, start screening at age 40.
​MRI-First Approach: If your PSA is high, many doctors now use a Prostate MRI before a biopsy to avoid unnecessary procedures.

17/02/2026

The link with Obesity and Cancer.

The link between obesity and cancer is one of the most significant areas of medical research in 2026. While most people associate carrying extra weight with heart disease or diabetes, obesity is now recognized as a leading preventable cause of cancer, second only to smoking.
​According to the International Agency for Research on Cancer (IARC), there are at least 13 types of cancer strongly linked to overweight and obesity.
​1. Which Cancers are Linked to Obesity?
​The risk isn't uniform across the body; it tends to affect specific organs, particularly those involved in hormone regulation and digestion:
​Digestive System: Colorectal, esophageal, liver, gallbladder, and pancreatic cancers.
​Hormonal/Reproductive: Post-menopausal breast, endometrial (uterine), and ovarian cancers.
​Other: Kidney, thyroid, multiple myeloma, and meningioma (a type of brain tumor).
​2. Why Does Excess Fat Cause Cancer?
​It’s a common misconception that fat is just "stored energy." In reality, adipose tissue (fat) is an active endocrine organ that pumps out chemicals. Here is how it triggers cancer:
​Chronic Inflammation
​Obese fat cells are often "stressed." This leads to a state of low-level, constant inflammation throughout the body. Over time, this chronic inflammation damages DNA and encourages cells to divide rapidly, increasing the chance of a cancerous mutation.
​The Insulin Factor
​Obesity often leads to Hyperinsulinemia (too much insulin in the blood). Insulin is a growth hormone; when levels stay high, it tells cells—including precancerous ones—to grow and stay alive when they should naturally die off.

04/02/2026

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive medical procedure used to break up kidney stones or stones in the ureter.
​Instead of surgery, ESWL uses high-energy shock waves (acoustic pulses) generated outside the body. These waves travel through soft tissue and "blast" the stone into tiny pieces—often described as "stone dust" or gravel—which can then be passed naturally through the urine.
​Who is a Good Candidate?
​ESWL is popular because it doesn't require incisions, but it isn't the right choice for every stone. Doctors typically recommend it for patients who meet the following criteria:
​Stone Size: Ideally, the stone should be less than 2 cm in diameter. Very large stones are harder to break effectively and might require multiple sessions.
​Stone Location: It works best for stones located in the kidney or the upper part of the ureter (the tube connecting the kidney to the bladder).
​Stone Composition: "Softer" stones (like those made of calcium oxalate or uric acid) break easily. "Hard" stones (like cystine or certain calcium phosphate stones) may be resistant to shock waves.
​Health Status: The patient should have healthy kidneys and no significant obstructions below the stone that would prevent the fragments from passing. Monroe Orlina