| LAPAROSCOPIC FELLOWSHIP IN RADICAL PROSTATECTOMY.
John F. Donohue University Hospital, Brest, France |
Prostate cancer is the most common tumour diagnosed in men after skin cancer. For those who choose radical treatment, surgery is the most popular intervention. There are no studies describing a definite advantage of this approach over the traditional open version but the perceived benefits, from the patients’ perspective, is a shorter stay in hospital and less discomfort following surgery allowing a quicker return to normal daily activities.
The first publication describing the results came from the United States in 1997 and the authors were not very enthusiastic about their results. However, two years later, a French team from Paris, published results on 65 cases and demonstrated that the laparoscopic approach was safe and feasible. The number of centres in the UK with experience in this procedure is limited and training opportunities are few.
It was with this in mind that I undertook to spend 6 months in France learning the technique and I arranged a fellowship with Professor Georges Fournier, head of the Urology Department at the Brest University Hospital in the Bretagne region in north-west France.
Prof Fournier started laparoscopic radical prostatectomy in 2000. He was mentored by Dr Bertrand Guillonneau while Guillonneau was at the Montsouris Institute in Paris and before he moved to the Memorial Sloan-Kettering Cancer Center in New York. Prof Fournier has performed over 500 cases to date and presently performs approximately 150 cases per year. Prior to undertaking laparoscopic radical prostatectomy, he performed only 20-30 open radical prostatectomies per year which highlights the increasing popularity of laparoscopic procedures.
My training consisted of initially assisting and then undertaking all the steps involved. Prof Fournier believes that laparoscopic radical prostatectomy is the most difficult laparoscopic operation to master and that there are 6 to 7 critical stages to achieve before becoming adept. This procedure cannot be learnt quickly and requires the investment of time which is difficult to obtain in the UK at present as many surgeons performing this operation are on the learning curve themselves.
I have now returned to the UK and am setting up a laparoscopic radical prostatectomy service in the south-east of England. This will involve the assistance of an experienced surgeon to act as a mentor for the first few cases. This is essential for anyone undertaking any complex surgery with the single most important aspect been patient safety.
I would like to acknowledge the generous support given to me by Prostate Research Campaign UK, without such assistance, it would not have been possible for me to undertake the fellowship.
Research summary dated 12 July 2006
Project 2005/02