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A selection from
Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
by Patrick C. Walsh, M.D., and Janet Farrar Worthington
pages 212-213
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Perfecting the Radical Prostatectomy
Baseball pitchers use videotape to perfect their fastball; tennis
players use it to get a better spin on their serve. The video camera is a
staple for most athletes, in fact: No respectable football coach would
dare contemplate next week's game without spending hours seeking
wisdom from hindsight, going over the this week's effort on the gridiron, play by play.
So why don't surgeons do the same thing? How are we ever going
to improve our technique if we don't analyze our own work this way?
Over the years, I have come to believe that very small differences
in surgical technique can have a major impact on outcome. Recently,
I put this theory to the test, watching my own operations. Using a
high-quality, three-chip video camera, I videotaped the operations on
the men discussed below (see "Continence and Potency: Quality of
Life After Radical Prostatectomy"). Then, eighteen months after that
study began, I reviewed these tapes. My goal was to make a good operation even better, by minimizing the operation's two major side
effects - incontinence and impotence. This is what I wanted to find
out: When a patient is continent and potent immediately after surgery, what made the difference in this man? I spent my summer vacation examining these videotapes, sometimes stopping them frame by
frame looking for insight. (Another bonus of the video camera is that
it allows surgeons a view of the entire operative field, and not just the
small area where we focus as we operate.) It took many hours of
intense scrutiny to watch sixty two-hour operations, but gradually I
was able to identify four slight variations in my technique - in controlling bleeding from the dorsal vein and dividing the sphincter -
that appeared to make the difference in the men who recovered sexual
potency the soonest.
Perhaps most exciting was that a new finding came out of this
research:
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