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.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
Now, if I had been in my shoes, I would have said, Menon, you're terrible. You don't know what you're doing. But Tuwari did have a filter between his brain and his mouth. You know, I would ask him, am I doing the right thing? And if he didn't, if he would do things a little differently, he would say, interesting, Dr. Menon, interesting.
And so that was my cord to take a step back and see what am I missing here? I could cope with that. But then he had... a hidden message for me which i couldn't cope with and that is when i really screwed up he would say wow you know at that point i really had to back off and uh and pause
Yep.
Yes, case one, I almost quit. It was an enormously expensive proposition to do this. We paid them close to six figures a week to come over here because I didn't want them to feel, God, why am I doing this? I wanted to make sure that it was there. And now I work for a big institution much like UC San Diego, and the analogy would be
You know, if Manoj wanted to recruit somebody from Australia to do nerve grafting and said, I want to pay him four times what I'm paying myself. I mean, institutions simply won't buy that. Our institution did because of the, this was grant funded, didn't cost them a penny. And the donors wishes that, you know, I should be given latitude to develop the program the best way that I did.
So the first robotic case was a very strong, muscular African-American. who had a Gleason 4 plus 4 cancer. Probably not the case that I should have picked, but just the way the informed consent was done, he happened to be the first person who agreed. And I felt ethically the person who agreed first should have this done.
And the surgeon who was doing it started doing the prostatectomy, went posteriorly, developed the planes, and was about to transect the urethra, but he couldn't figure out where the prostate ended and where the urethra started. And that's just because this person was so muscular and the robot magnification was different from the laparoscopic magnification.
And the anatomy in an African-American pelvis is different from a Mediterranean pelvis. So I think we spent about an hour arguing about where to cut the urethra. I couldn't tell him where to cut it. I mean, he was the surgeon. I mean, I was learning from him. But We ended up opening him up. And I ended up having to do an open radical prostatectomy.
And it's really difficult to do an open radical prostatectomy in a person with unfavorable anatomy who has had four hours of laparoscopic surgery. But the only thing that I learned from it is that I knew the anatomy in my patients better than the French surgeons did. Because I was used to seeing this anatomy and they weren't.
So where I wanted to transect the urethra laparoscopically was where I ended up transecting the urethra open. And, you know, we did the case and I went home and I got a call saying, The patient isn't moving his leg. He's paralyzed. So I said, call the neurosurgeon and I'm coming in. And as I was driving in, I said, if this person doesn't move, I'm going to cancel the program.
You know, we were legally bound to honor their contract for a year. This was their first case. So I would somehow have to justify this with our administration and the donor, because I'd spent a lot of money into this. We had agreed to buy the robot, which was, you know, a million dollars, $999,000. But I couldn't conscientiously have a patient become paralyzed because I was trying something new.
By the time I went there, the patient was moving. When I was told that it was either stretch on the sciatic nerve or the femoral nerve, I forget which, maybe from the retractors on the femoral nerve or the sciatic nerve from the reverse Dellenberg position with the hips flexed, and that he would be okay. And he was okay. He had a Gleason 9 cancer with seminal vesicle invasion.
He was incontinent and impotent. Not the best way to start the program. But I saw him 14 years later. He has an undetectable PSA. He is incontinent and he's potent and he's a fan of the procedure that he go figure.
I'm not sure, you know, one of my closest friends, Paul Schellhammer, Well, it was in the OR because he wanted to see robotics. So he was there for this case, and Paul's an absolute gentleman. It kind of shocked him as to how primitive we were. But I think what he told me is, I like the way that you converted him to open.
So Paul became a friend, and he got a robot for Eastern Virginia Medical School much before UCSD got one or UCSF or UT Southwestern.
Yes.
The lenses that we dealt with were called POC, and they were fuzzy, and I couldn't see through them, and I would constantly complain to Intuitive, you need to get me better lenses. You can't send me out to do these cases with these lenses. And they said, oh, no, these are the best lenses known to mankind. Well, now they call them the POC lenses, piece of crap for POC.
But they did get better lenses. The next set of lenses were the Shoei system, which was very good. And then they got the Olympus. And then they got the SI system, or the S system, which was high definition, and the SI. So, I mean, it's very, very different technology. But Maybe it's like a car that you drive today and you compare it to a car that you were driving in the year 2000.
I mean, both the cars would get you where you wanted to go, but there's no question that any car that you buy today is much better than the car that you could get 20 years ago.
The answer is yes, but there was something that I had meant to touch upon. I'm going to put you on the spot now. No good deed ever goes unpunished, and you've been incredibly gracious. So let's say you were me. You were starting in Michigan, or let's just say you were starting in Michigan. trained with Pat Walsh, and you thought you were a pretty good open surgeon.
Showing 81–100 of 122 · page 5 of 7
← Previous
Next →