Center for Minimally invasive and Robot Assisted Surgery

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

04/02/2026

What is ESWL? Who are good candidates for these procedure?
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.

30/01/2026

The Hybrid advantage, developing the "SIXTH SENSE" in robot assisted laparoscopic surgery:

Surgeons who rotate through both roles often develop a "sixth sense" for the procedure. They can anticipate the needs of their partner, troubleshoot mechanical hitches faster, and generally run a much more efficient operating room. It turns a solo performance into a synchronized "cockpit" environment.

In the world of robotic surgery (like the DaVinci system), the roles of the Console Surgeon and the Bedside Assistant are often seen as a hierarchy, but maintaining proficiency in both offers a massive tactical advantage.
​ Think of it like a pilot who also knows exactly how the ground crew services the engine—it makes the entire flight smoother.
​1. The Console Surgeon’s Perspective
​The surgeon at the console is the "brain" of the operation, utilizing 3D visualization and wristed instrumentation. The benefits of this primary role include:
​Ergonomics: Traditional laparoscopy is physically grueling. At the console, you are seated in a neutral position, which reduces surgeon fatigue and tremor, leading to higher precision during long cases.
​Enhanced Visualization: You have a high-definition, 10x magnified view of the anatomy that no one else in the room sees quite as clearly.
​Autonomy: You control up to three instruments and the camera simultaneously, reducing the "lag" that occurs when asking an assistant to move a camera or retract tissue.
​2. The Value of Occasional Bedside Assisting
​Even for an experienced lead surgeon, stepping back to the bedside (the "Patient Side") is an incredible professional development tool.
​Spatial Awareness: At the console, you lose a sense of external space. By assisting, you stay grounded in how the robotic arms interact externally. This prevents "arm collisions" when you go back to the console.
​ Port Placement Mastery: A great surgery starts with great port placement. Being at the bedside allows you to refine where the trocars are placed to maximize the robot's range of motion.
​Empathy and Communication: When you assist, you realize how difficult it is to follow certain commands. This makes you a clearer, more patient communicator when you are back in the driver's seat.
​Safety Training: If the robot fails or an emergency conversion to open surgery is needed, the person at the bedside is the first line of defense. Keeping these manual skills sharp is vital for patient safety.

Feature Console Surgeon Bedside Assistant
View 3D, Immersive, Magnified 2D Monitor
Primary Task Dissection, Suturing, Resection Retraction, Suction, Stapling
Physical Strain Low (Seated) Moderate (Standing/Reaching)
Key Skill Micro-precision & Strategy Team Coordination & Troubleshooting

28/01/2026

What does it take to become a proficient console surgeon in robot assisted laparoscopic surgery?

Becoming a proficient console surgeon is a marathon, not a sprint. It requires a transition from traditional tactile surgery to a "digital" mindset where you rely entirely on visual cues and advanced technology.
​The pathway is typically broken down into three distinct phases:

Pre-clinical, Simulation, and Clinical Progression.

​1. The Pre-Clinical Foundation
​Before touching a patient, you must master the "hardware."
​System Knowledge: Completing manufacturer-led training (like the da Vinci Technology Training Pathway) to understand the stack, the arms, and the emergency stop protocols.
​Bedside Experience: As discussed, you usually need to assist in 10–20 cases at the bedside. You cannot lead from the console if you don’t understand the physical limitations of the arms and ports from the outside.
​2. High-Fidelity Simulation
​You must reach "expert-derived" benchmarks on a simulator. This isn't just about finishing the task; it’s about doing it efficiently. Key metrics tracked include:
​Economy of Motion: Minimizing unnecessary instrument travel.
​Clutching Frequency: Properly using the "clutch" to keep your hands in a comfortable, ergonomic workspace (the "sweet spot").
​Bimanual Dexterity: Using your non-dominant hand as effectively as your dominant one.
​Mastery of the "Third Arm": Learning to retract with one arm while actively operating with the other two—essentially juggling three instruments at once.
​3. Clinical Progression (The Learning Curve)
​Proficiency is generally defined by volume and outcomes, not just time.
​The Magic Number: While it varies by specialty, data suggests that 40–80 cases are required for basic comfort, but 150+ cases are often needed to reach "elite" status where complication rates and operative times plateau.
​Modular Training: You don't do the whole surgery at first. You start with "modules"—for example, performing just the bladder neck dissection in a prostatectomy or just the docking and initial mobilization in a hernia repair.
​Proctoring: Your first several independent cases are usually overseen by a proctor—an expert surgeon who can step in or provide real-time guidance via a dual-console setup.

25/01/2026

Supine Ultrasound and Fluoroscopy Guided Percutaneous Nephrolithotomy for staghorn calculus

24/01/2026

Mogi Cobangbang Daniel Adam Levy

23/01/2026

The bedside assistant in robot assisted laparoscopic surgery