Dr. Mani Menon
speaker
122 appearances
1 recordings
1 series
first heard Sep 2024
last heard Sep 2024
Dr. Mani Menon’s voice in public audio — every appearance, attributed to the second.
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Appearances
Well, you know, as I said, I was a wimp, so I had to do my groundwork to make sure that the patients didn't suffer. I didn't want the patients to suffer because I hated complications, but I also felt this was not a way that I could repay somebody for their philanthropy. I had to make sure that I succeeded so that he succeeded. And actually, at the time we got the funding, there was no robot.
It was not FDA approved. So the goal was to develop a laparoscopic radical prostatectomy program. And I had done some laparoscopy when I was at UMass, but I rapidly realized that I was not a laparoscopic surgeon. I didn't want to do that. So I had one of the junior people do it. And all they did was laparoscopic lymph node dissection.
Laparoscopic radical prostate surgery was a whole different thing. I called up the best laparoscopic surgeon I knew. A person had just written a paper about doing laparoscopic radical prostate surgery. And that was Lou Cavusi at Hopkins. And I said, Lou, what do you think about laparoscopic prostate? And he said, it's a terrible idea. He said, I've tried doing it.
And, you know, I'm a very good laparoscopic surgeon. I'm pretty good. But this operation brought me to my knees. So I said, OK, let me call Alan Parton, who you know, was in the next office and was an open surgeon, and maybe he would see the value of laparoscopy. And Lou was not a prostate cancer surgeon. Ditto from Alan Barton, saying, this is a terrible idea. You should never do that.
It's a really bad operation. So I decided I was going to do it. I mean, these two people said, no, I was going to do laparoscopic prostatectomy. I thought I would call Ralph Klayman. I'm cashing in all my IOUs here. So I called Ralph and said, Ralph, what do you think about laparoscopic prostatectomy? And he said, you know, buddy, this is a terrible idea. I mean, I've heard you.
You've had some good ideas and some bad ideas, but this is the worst idea that I've heard from you. But knowing you, you've already talked to Luca Vusi and he's told you it's a terrible idea and you've decided that you want to do it anyway. So let me stack the deck a little bit in your favor. Go talk to Bertanghino in Paris. He is the only person who can do it.
And if you can collaborate with Bertanghino, you might have a job. And I said, well, I called you thinking maybe you would come and do it. He said, I'm not going to do it. He said, And I said, why not? I mean, you're the father of laparoscopic surgery. He said, buddy, you can take a golf club and put it in any golfer's hands, and there'll only be one Tiger Woods.
And that Tiger Woods is Bertrand Guillot. So I got on a plane and went to meet Bertrand. And the short thing of this is I arranged for them to come down one week a month to do laparoscopic prosthetics, straight laparoscopy. And we would batch our cases. They would do them five days in a row, nine cases a week. And then we wouldn't do any for another three weeks. And they would teach me.
And it wasn't pretty. I really did not like doing laparoscopic surgery. But it also wasn't that pretty. when they did it, not to me. It was magnificent when they did it in Paris. It was not as good as I had seen Walsh do the open radical prostatectomies here. And the big difference was the BMI in body weight. The French patients had a BMI of 21, 22.
You put the laparoscope in and the prostate was begging to be taken out. whereas the Detroit patients had a BMI of 35. It was a struggle, just going through seven inches of fat on the anterior abdominal wall. And this became very apparent to me when Bertrand and Guy Valencian came.
Bertrand was an Olympic-level fencer, incredible athlete, and he stayed with me during this whole year when he was doing it. We would do two cases and he would just come home and collapse. Whereas I would see him in Paris and he would do three or four cases and would bicycle 15 miles to his home.
And Brassand essentially said, if I were an American surgeon, I would not have developed laparoscopic prostate. I mean, we are so lucky to have the people that we have. And then Barsan left for Memorial Sloan Kettering. And I had two choices, close the program or come up with something else. And the robot was there. I had seen it in Montsouris.
Guy Valencien had a mobile robot or a rotating robot for a week. And Valencien had asked me to sit down and do a little bit of the dissection. And I loved it. I thought while I was very sure I couldn't do a laparoscopy, I was pretty sure that I could do robotics. So I got the robot and we would run two rooms in parallel.
I would start the robotic case in one room, and in the next room, Bhatand would do a laparoscopic case with Jim Peabody and the residents. So it would be Tiwari and I doing the robotic case, and Bhatand and Jim and someone else doing the laparoscopic case. I could operate for about 20 minutes, and then the tension was too high.
You could see the band around my forehead from pushing my head into the console visor. Within about 40 minutes, Bhattacharya would have finished the laparoscopic case, and then he would come. We would remove the ports. He would put the laparoscopic port, same ports. So he would just change instruments and complete the laparoscopic prosthetic. This went on for about three cases.
On the fourth case, I finished my case before he had done his 1,000 laparoscopic prostate. That was just a fluke. I mean, I think this patient had good anatomy, and Bhartan's patient did not have good anatomy. We didn't know what it was on the outside. They both looked the same, but on the inside, they were very different.
So like your governor from California said, I felt that there must be a pony in there somewhere. If I could, at four cases, be quicker than Bhartan was at 1,000 cases, Maybe I could learn from that. That's what happened. I mean, the fifth and sixth case, I was no longer as quick. But by the 18th case, I was reproducibly quicker than the laparoscopic surgeons.
The blood loss was the same, and the outcomes, as we could see it, were the same. The margin rates and the biochemical recurrences were the same. So once again, because we had to do our cases when the French surgeons were there, we batched them. So we would do five robotic cases in a week while they do five laparoscopic cases. And at the end of it, we would collect the data and see how things did.
We videotaped every case and we would go over the case at the end of the day, even though we would dog-tired and tried to figure out what bad moves I had made and what good moves I had made. And everything was fair game. I mean, the nurses, the anesthetists, they were all part of this team. I insisted on the same anesthetists and the same nurses. And the residents were the same. It was all Tiwari.
And we would, you know, try to find out what, how we could improve. But then when we went to the OR, I didn't want 10 people giving me 10 different approaches of doing this. Why don't you cut here? Why don't you cut there? And all that. The time for that discussion was over. I was going to do it my way, unless they saw something really that I was doing that was really terrible.
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