Pause and replay that operation

Prostate: One of the nation's pre-eminent urologic surgeons produces a DVD of his most successful techniques, with a grateful patient helping to foot the bill for distributing it.

Medicine & Science

July 12, 2004|By Dennis O'Brien | Dennis O'Brien,SUN STAFF

IN A world saturated with training films, the DVD that Patrick C. Walsh mailed to thousands of physicians this spring might be the first of its kind.

For one thing, it's free. For another, it's about sex and the middle-age man.

The DVD shows doctors how to remove a prostate using a method that Walsh pioneered in the 1980s and spent 20 years refining - a method that's far less likely to result in impotence and incontinence than earlier techniques.

"You want these people to be alive, but you also want them to be happy they're alive," Walsh said.

The 66-year-old surgeon, who runs Johns Hopkins' Brady Urological Institute, sent copies of the video to 40,000 physicians who belong to the nation's leading urological societies. An additional 15,000 are available to doctors who ask for them.

Physicians have increasingly turned to technology for teaching over the years, churning out videotapes and DVDs, and even streaming live videos of procedures over the Internet.

"It's not something that replaces traditional, hands-on medical training, but it is one teaching tool," said Dr. William Carey, director of continuing education at the Cleveland Clinic, a teaching hospital that is launching its own series of videos on surgical techniques.

But Walsh's DVD is different. He financed the slick production with the help of a grateful patient so that he could distribute it free of charge.

"I could have gone to a drug company and asked for financing," he said. "But then they would have control of it and control who sees it. I wanted to have something I could give to everyone in the world -including doctors in developing countries."

Prostate cancer, the most common form of cancer in males, kills about 30,000 every year. It eventually strikes one male out of six.

Walsh is adamant that prostate surgery does not to have to cause its two most dreaded aftereffects: sexual impotence and incontinence.

The outcome, he insists, depends on the patient's age, the stage of the cancer and the extent of nerve damage. But it also depends on the surgeon's skill, he says, and that's why the DVD is important to him.

Urologic surgeons often vary in their approach to the operation - changing the order of the instruments they use, the sequence of suturing or the anatomic areas on which they focus.

The 90-minute film shows a step-by-step radical prostatectomy - a prostate removal - identifying the sequence of steps and the instruments Walsh uses for each step, with close-up shots of the action and detailed illustrations of nearby organs and nerves. It won't sell much popcorn, but it is drawing positive reviews.

"It was really high quality, particularly the illustrations," said Dr. Eric Klein, head of urologic oncology at the Cleveland Clinic. "I think the commentary was extremely helpful."

Walsh calls the DVD his "magnum opus" and repeats his reason for making it: "If you've been given the privilege of sailing in uncharted waters, you have the responsibility to make those charts."

Heralded as the nation's premiere prostate surgeon, Walsh has a quiet voice and enormous self-confidence. Doctors come from around the world to watch him work.

His patients have included Democratic presidential candidate John Kerry, columnist Robert Novak and former Washington Mayor Marion Barry Jr.

"He makes it look easy, but believe me it's not," said Dr. Alan Woolfenden of the Royal Liverpool University Hospital, who was in town recently to watch Walsh operate.

Production of the DVD began five years ago when Hopkins staff artist Juan Garcia began working on unprecedentedly detailed drawings of the structure and relationships of the prostate and surrounding nerves, tissues, blood vessels and organs.

"If you look at Gray's Anatomy, you won't see these kind of illustrations in there," Garcia said.

The project picked up momentum two years ago, when a New York patient agreed to cover the $100,000 tab for producing 55,000 DVDs and distributing them worldwide.

"He told me about what he wanted to do, and I told him I couldn't think of anything more important," said Robert Baker, 69, a real estate developer in Purchase, N.Y., who had his prostate removed in May 2002.

The prostate is a walnut-sized organ, wedged against the bladder, that produces part of the seminal fluid in ejaculations.

The first prostate removal was performed at Johns Hopkins in 1904, but historically the operation was messy - surgeons worked blindly in a pool of blood because the organ is located so deep inside the body. And their knowledge of the area's anatomy was hazy because details of the surrounding tissues in the cadavers they studied were obscured by preservatives.

Walsh began trying to change that soon after he came to Hopkins by making detailed observations of the veins around the prostate. Eventually, he developed methods for clearing the area of much of the blood during surgery.

"I was using the operating room as my anatomy lab," he said.

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