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
In fact, you were the first open surgeon outside of Hopkins who had done a nerve-sparing radical prostatectomy, even before Peter Scardino or Bill Catalona had done it, just because you happened to train with Dr. Walsh when that did, being in the right place at the right time. And you have a patient that you want to explain to him about robotic radical prostatectomy.
You've done a thousand open radical prostatectomies. You're a good open surgeon. You've done 18 robotic cases, and you're kind of feeling that you're getting ready to, this is something. How do you counsel a patient as to whether he should do open cases or robotic cases? I mean, how exactly would you approach the patient?
That's exactly what I did, more or less exactly what I did. And then we measured everything. So I looked at the first 100 patients I had counseled, and 70 of the 100 chose robotic surgery and 30 chose open radical prostatectomy, which surprised me. I would have thought it would be the other way around, or maybe 10% would choose robotics. And then I tried to find out why they did that.
And this was the reason I wanted to mention this. I wanted to give a shout out to these hundreds of the early patients who were incredibly brave. These were all people who worked in the automotive industry on the assembly line. And at that time, and even now, I think, Detroit had the highest concentration of industrial robots in the world.
They were all used at Ford and GM and what was then called Chrysler and AMC. So what they felt is they had seen the power of the robot in welding and soldering and screwing, no pun intended, in areas where the hand couldn't get into.
What they felt is that they came here because they trusted me and I had told them that I was very well trained in open surgery and they said, well, if you think this robot is going to help you, we've seen how it helps us. What do we have to lose? If you're not able to do it, you will just do the open operation.
I don't see that happening at Sinai, where Tuareg is dealing with Wall Street bankers and high-powered attorneys and New York Yankees players and things like that, and everybody wants a fifth opinion and a sixth opinion before they do that. I don't know that I would see it at UC San Diego. But it certainly happened in Detroit.
And I want to reach out to these people who worked under very difficult circumstances, under very trying economic conditions, but they had faith. They had faith in their physician doing what they thought was right. And I guess some of them, they liked the idea that I wasn't exposing the cancer to it.
It's a mode of life. I did not train them to do the greatest number of cases or write the greatest number of papers. I tried to tell them to take care of their patients and be kind and decent and generous with their time. and I've learned from the people. I mean, my boss is somebody whom I had trained, and I mean, I've told you about all the bosses that I've had problems with.
This boss I don't have a problem with, and it isn't that I changed. It's that he's just a good human being.
No, no. I don't go to the OR, so I guess there's less chance of a wow and an interesting there. The thing that I am frustrated about were two of the last things that I did in robotics which haven't caught on. You know, we first did prostatectomies and it took four or five years, but as you said, that's now become standard of care.
Well, then I was told that you can do prostates, but there's no point in you doing kidneys, and it should either be done open or laparoscopic. Well, now laparoscopy is true, but most of the difficult cases that you do with a robot, most people won't be able to do laparoscopically in fear of any cable thrombus and so on and so forth.
I may have done the first robotic inferior vena cava thrombus in the world, level three thrombus, or level two, two and a half thrombus, together with Rani Abaza. And that's now accepted in places other than Memorial Sloan Kettering. And then we took the robot and went to Mansoorah so that we could learn how to do robotic cystectomies. I did a cystectomy a day, 15 days in a row,
where the Egyptian surgeons were doing an open cystectomy 15 days in a row, and then we compared data. We did that, and that's been successful. I mean, Peter Wickland, who is here, has done over 600 radical cystectomies in New York, at Sinai, in addition to the thousands he's done in Europe. But there were two things that I tried which have worked technically but have not caught on.
One was robotic kidney transplants. It has caught on, but the main reason it hasn't caught on in the U.S. is that the transplant surgeons are not as skilled in robotics as the urologic surgeons are, and the transplant surgeons do the transplants. In India, kidney transplants are done by urologists and it's taken off. And in Europe, in many places, it has taken off.
But I had hoped that would be my swan song contributions to urology. We also... I came to the conclusion that most, if not all, people with intermediate-risk prostate cancer should not have a radical prostatectomy because the side effects of ED are about 50% across the country. If you can identify an area where there is no cancer, you can preserve it.
In particular, the nerves that maintain penile erection, the nerves that make nitric oxide, half the nerves are where Walsh's neurovascular bundle is. or Menon's veil, or Tuareg's hood are, but half of them are between the prostate and the seminal vesicle and around the seminal vesicle. And if you do nitric oxide staining, that's where the nerves are.
And very simply, the more nerves you preserve, the better the outcome is. And if you can figure out a way to preserve those nerves that are around the seminal vesicles, and these are microscopic nerves, you really need to stain them to see them. There's no landmark to them other than you know they're there. The potency rates are about 90%.
So this is something, a modification of radical prostatectomy that my patients called Menon's precision prostatectomy. And I've not been able to get traction on that. We've written about it. We've published it. I have eight-year data on it. And the data is robust. But for some reason, I came across it as I was in the latter part of my career.
Had I thought about this five years before I did, this would be the standard of care, much like nipple-sparing mastectomy for breast cancer has replaced radical mastectomy.
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