HIFU

High Intensity Focused Ultrasound, or HIFU, is a therapy that destroys tissue with rapid heat elevation-which essentially destroys the tissue. Ultrasound energy, or sound waves, is focused at a specific location and at that “focal point,” the temperature raises to almost 90 degrees Celsius in a matter of seconds. Any tissue at the “focal point” is destroyed; however, any tissue outside of the focal point remains unharmed.  Tulane was an FDA trial site for HIFU and now offers this treatment for those who qualify.

Patients who have been diagnosed with prostate cancer or who have been previously treated with radiation therapy and may potentially have recurrent prostate cancer may be candidates for this treatment.

Inclusion Criteria:

  • Select men on Active Surveillance, with known diagnosis of prostate cancer.
  • Men with initial presentation of organ-confined recurrent prostate cancer (Clinical Stage T1c or T2a only), who have been treated with external beam radiation.
  • PSA less than10 ng/mL, greater than0.5 ng/mL
  • Negative bone scan, negative Axumin scan or negative PSMA scan (all available at Tulane Medical Center)
  • Age 40 – 85 years old

What is Laparoscopic Surgery?

Tulane Urology has a long history of performing laparoscopy, and was the first in the entire region to offer this since 1991, in urology.  Laparoscopy is a technique for performing major abdominal surgery through several tiny (0.5 to 1 cm) incisions, instead of the large, 12 inch incisions that have been used in the past. Laparoscopy involves a high resolution video camera so that organs such as kidneys, adrenals, prostate, and ureters can be visualized with a 1-cm telescope, and manipulated with instruments through these small, 0.5 to 1 cm incisions on the abdomen. Because of their small size, these incisions produce much less discomfort/pain after laparoscopy than the scar associated with large incisions required for open surgery. With laparoscopy, the need for pain medication, the length of hospital stay, blood lost and recovery time are greatly reduced. Laparoscopic surgery requires general anesthesia. Although laparoscopic surgery is easier on the patient than open surgery, it requires great surgical skill and technique which require specialized training.

Laparoscopy is established in the mainstream of urologic surgery. Indeed, it is becoming increasingly clear that almost all aspects of retroperitoneal surgery, be it kidney, ureter, adrenal gland, prostate, or lymph nodes, can now be achieved laparoscopically with far less injury and pain to the patient. Minimally invasive surgery has superseded open surgery at major medical centers throughout the US and the world.  Today, the craft of open, large incision surgery has an ever-diminishing role in the treatment of urologic disease.

Benefits of Laparoscopic Surgery

  • Several documented benefits in comparison with traditional open surgery have been demonstrated including:
  • Less postoperative pain
  • Less blood loss
  • Shorter hospital stay
  • Favorable cosmetic result / smaller scars
  • Earlier return to work and normal daily activities

Laparoscopic surgery cannot be performed if you have:

  • Uncorrectable coagulopathy
  • Intestinal obstruction
  • Abdominal wall infection
  • Suspected malignant ascites

Also, relative contraindications include morbid obesity, extensive prior abdominal or pelvic surgery, ascites, pregnancy, severe chronic obstructive pulmonary disease (COPD), and severe cardiac arrhythmias or heart disease.

Complications

Complications are decreased in experienced surgeons who perform laparoscopy on a routine basis. The estimated complication rate of laparoscopic surgery is less than 5%. The associated mortality rate is about 0.3% and conversion rate was 1-5%. Risks of surgery include bleeding, infection, injury to adjacent organ such as liver, bowel, spleen or pancreas, as well as possible conversion to open surgery.  Conversion to open surgery might be necessary to safely complete the planned procedure, which occurs < 5% in experienced hands.

Robotic Prostatectomy

Tulane Urology was the first in the entire region and Gulf South to perform DaVinci Robotic surgery in 2002 and onwards.  A minimally invasive surgical procedure,  robotic prostatectomy uses finely controlled robotic instruments to perform the prostatectomy safely, while enhancing patient recovery and outcome. Doctors control the devicewhich consists of high-resolution cameras and micro-surgical instruments. Powered by state-of-the-art robotic technology, doctors’ hands movements are scaled, filtered, and seamlessly translated into precise movement of the EndoWrist Instruments.

Unlike laparoscopic surgery, instruments used in robotic prostatectomy can turn in all directions with 90 degrees of articulation and 7 degrees of freedom, mimicking human wrist movements. During robotic prostate surgery, the robot provides the surgeon with improved visualization, 3-D vision, dexterity, and precision compared with open or laparoscopic surgery, while enabling operation through 1-2 cm incisions. This allows doctors to perform fine computer-controlled movements and a more precise and minimally invasive robotic prostatectomy. During this prostate cancer treatment, the patients’ delicate prostate nerves that control bladder and sexual function can be preserved depending on the clinical presentation.  Robotic prostatectomy achieves the same or better prostate cancer treatment results than a surgeon’s own hands in open or laparoscopic surgery.