Roger Kirby

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The Urology Foundation – Cycle Vietnam to Cambodia

November 9, 2017/49 Comments/by Roger Kirby

Since 2008 we have cycled in Sicily, Malawi, Madagascar, Patagonia, South Africa and Rajasthan raising more than three quarter of a million pounds for The Urology Foundation. The seventh and latest instalment of the TUF cycling series is an amazing 450km cycle challenge through two of South East Asia’s most fascinating countries. The challenge starts in Vietnam’s Ho Chi Minh City and finishes at the world heritage site of Angkor Wat in Cambodia. En route we will shed a lot of sweat, but also experience breathtaking scenery, ancient temples and the warmth of the local people.

The cycling will be tough but we are going to be using bikes from ecosmobike.com to make it less harder, it will be in hot and humid conditions, but the camaraderie along the way will be very special as doctors, patients and supporters team up to raise much needed funds for The Urology Foundation (TUF).

Funds raised by Cycle Vietnam to Cambodia will enable The Urology Foundation to help improve the management and treatment of urological diseases through the development and support of medical education and sponsorship of research – training healthcare professionals specialising in urology and supporting basic and clinical research by funding scholarships in the UK and abroad.

Day One (Fri 10 November 2017) – Depart UK

Overnight flights from London to Ho Chi Minh City, Vietnam

Day Two (Sat 11 Nov) – Arrive Ho Chi Minh City – Transfer Ben Treh

On arrival in Ho Chi Minh City we are met at the airport by our support team where buses will be waiting for us to transfer, approximately two hours, to our hotel in the town of Ben Treh. In the afternoon we will have the bike fitting. Dinner will be at the hotel and will be followed by a briefing about the challenge ahead.

Day Three (Sun 12 Nov) – Ben Tre – Tra Vinh 50kms (approx. 31 miles)

Today we will have a warm-up day with the cycling being relatively easy and the distance not too challenging. After breakfast we cycle out of the hotel along lovely country roads with very little traffic. We then follow a traffic free route through villages that give us an insight into Vietnamese rural life. After crossing a number of river tributaries by bridge we reach one that requires a short ferry crossing. About an hour later we reach the main Mekong River where we re-group for a longer ferry crossing.

Day Four (Mon 13 Nov) – Tra Vinh – Can Tho 104kms (approx. 64 miles)

The cycling today is fairly flat and takes us through rural communities and a number of small towns. Interest today is provided by the many Pagodas that we pass, some of which we will use for rest stops.

Day Five (Tues 14 Nov) – Can Tho – Chau Doc 70kms (approx. 43 miles)

We leave our hotel early this morning with a road transfer of approximately 2.5 hours. We start cycling from the town of Am Cham. We stop at a local restaurant in the small town of Triton for lunch before continuing through scenic agricultural land. This afternoon we encounter our first major climb. Further, smaller climbs take us into the town of Chau Doc where we find our overnight hotel. On arrival we will de-fit the bikes in preparation for our crossing into Cambodia.

Day Six (Wed 15 Nov) – Chau Doc – Phnom Penh

Today we enjoy a day off the bikes and a fascinating journey by boat from Vietnam to Cambodia. After breakfast we have a short transfer to the harbour where we embark on the boats that will take us along the historic Mekong River to the border.

We will see many boats along the way and experience life on the river which supports many thousands of Vietnamese. After crossing the border we continue our journey up-river to the city of Phnom Penh where we have lunch in a restaurant overlooking the busy harbour.

We will visit the Royal Palace which is described as an impressive Khmer style Palace. We overnight at a hotel in Phnom Penh where we will be briefed by our Cambodian support team.

Day Seven (Thurs 16 Nov) – Phnom Penh – Kampong Cham 60kms (approx. 37miles)

Today we have our first day of cycling in Cambodia. Following an early breakfast we will have a short transfer to take us out of the city to the surrounding countryside where quiet roads await us. After about 35kms we reach the end of the tarmac road and continue the rest of today on dirt roads. We overnight in the town of Kampong Cham.

Day Eight (Fri 17 Nov) – Kampong Cham – Kompong Thom 107kms (approx. 66 miles)

This is probably our most demanding day of cycling. After breakfast we leave town on an undulating road that passes many Temples and Pagodas and leads us into a forest of rubber trees. We will have lunch today in a large Pagoda complex before continuing our ride into the town of Kampong Thom.

Day Nine (Sat 18 Nov) – Kompong Thom – Siem Reap 60kms (approx. 37 miles)

This morning after an early breakfast we have a transfer of approximately 1 hour to our start point at Kampong Kdei. Our route today takes us through the Cambodian countryside until we reach the outskirts of Siem Reap. Our finish line will be at the entrance to the ancient city of Angkor where we will enjoy a celebratory drink and have a photo opportunity. This evening we will have our celebration dinner at a nearby hotel; this will be followed by a cultural show.

Day Ten (Sun 19 Nov) – Siem Reap – Visit Angkor Wat / Free Day

Today is a free day to explore the areas ancient ruins and temples, or relax by the pool, or do a spot of shopping. Why not re-visit the Angkor Wat temple, take a walking tour of the overgrown ruins of Ta Prohm which is entwined with tree roots and gigantic creepers, visit the tranquil Bayon with its multitude of serene stone faces, or see the impressive 350m long Terrace of the stone Elephants.

Day Eleven (Mon 20 Nov) – Depart Siem Reap

We depart for the airport at Siem Reap to begin our journey home.

Day Twelve (Tues 21 Nov) – Arrive UK

Altogether we will have cycled 450 Km in extremely hot and humid conditions. Do support us with a donation to a great cause by sponsoring Louise de Winter our CEO’s fundraising page here:
https://cyclevietcam2017.everydayhero.com/uk/louise-de-winter All donations made will go towards funding the vital research, training and education in urology diseases so badly needed.

Roger Kirby

The Prostate Centre, London

RSM Urology Winter Meeting 2017, Northstar, California

February 17, 2017/6 Comments/by Niyati Lobo

This year’s Annual RSM Urology Section Winter Meeting, hosted by Roger Kirby and Matt Bultitude, was held in Lake Tahoe, California.

A pre-conference trip to sunny Los Angeles provided a warm-up to the meeting for a group of delegates who flew out early to visit Professor Indy Gill at the Keck School of Medicine. We were treated to a diverse range of live open, endourological and robotic surgery; highlights included a salvage RARP with extended lymph node dissection and a robotic simple prostatectomy which was presented as an alternative option for units with a robot but no/limited HoLEP expertise.

On arrival to Northstar, Dr Stacy Loeb (NYU) officially opened the meeting by reviewing the social media urology highlights from 2016. Next up was Professor Joseph Smith (Nashville) who gave us a fascinating insight into the last 100 years of urology as seen through the Journal of Urology. Much like today, prostate cancer and BPH were areas of significant interest although, in contrast, early papers focused heavily on venereal disease, TB and the development of cystoscopy. Perhaps most interesting was a slightly hair-raising description of the management of IVC bleeding from 1927; the operating surgeon was advised to clamp as much tissue as possible, close and then return to theatre a week later in the hopes the bleeding had ceased!

With the promise of beautifully groomed pistes and stunning views of Lake Tahoe, it was hardly surprising that the meeting was attended by a record number of trainees. One of the highlights of the trainee session was the hilarious balloon debate which saw participants trying to convince the audience of how best to manage BPH in the newly inaugurated President Trump. Although strong arguments were put forward for finasteride, sildenafil, Urolift, PVP and HoLEP, TURP ultimately won the debate. A disclaimer: this was a fictional scenario and, to the best of my knowledge, Donald Trump does not have BPH.

The meeting also provided updates on prostate, renal and bladder cancer. A standout highlight was Professor Nick James’ presentation on STAMPEDE which summarized the trial’s key results and gave us a taste of the upcoming data we can expect to see in the next few years.

We were fortunate to be joined by prominent American faculty including Dr Trinity Bivalacqua (Johns Hopkins) and Dr Matt Cooperberg (UCSF) who provided state-of-the-art lectures on potential therapeutic targets and biomarkers in bladder and prostate cancer which promise to usher in a new era of personalized therapy.

A personal highlight was Tuesday’s session on learning from complications. It was great to hear some very senior and experienced surgeons speaking candidly about their worst complications. As a trainee, it served as a reminder that complications are inevitable in surgery and that it is not their absence which distinguishes a good surgeon but rather the ability to manage them well.

There was also plenty for those interested in benign disease, including topical discussions on how to best provide care to an increasingly ageing population with multiple co-morbidities. This was followed by some lively point-counterpoint sessions on robot-assisted versus open renal transplantation (Ravi Barod and Tim O’Brien), Urolift vs TURP (Tom McNicholas and Matt Bultitude) and HOLEP vs prostate artery embolization for BPH (Ben Challacombe and Rick Popert). Professor Culley Carson (University of North Carolina) concluded the session with a state-of-the art lecture on testosterone replacement.

In addition to the excellent academic programme, delegates enjoyed fantastic skiing with perfect weather and unparalleled views of the Sierra Nevada Mountains. For the more adventurous skiiers, there was also a trip to Squaw Valley, the home of the 1960 Winter Olympics. Another highlight was a Western-themed dinner on the shores of Lake Tahoe which culminated in almost all delegates trying their hand at line dancing to varying degrees of success! I have no doubt that next year’s meeting in Corvara, Italy will be equally successful and would especially encourage trainees to attend what promises to be another excellent week of skiing and urological education.

Miss Niyati Lobo
ST3 Urology Trainee, Brighton and Sussex University Hospitals NHS Trust

@niyatilobo

TUF Cycle India

September 17, 2015/88 Comments/by Roger Kirby

The Urology Foundation Cycle Challenge in Rajasthan

19 – 28 November 2015

In memory of Professor John Fitzpatrick

After the gruelling cycling challenges in Sicily, Malawi, Madagascar, Patagonia, and most recently South Africa, which together have raised many hundreds of thousands of pounds for The Urology Foundation (TUF), our next Challenge is a 500 Km ride through Rajasthan, India. We now have 50 intrepid cyclists signed up and ready to participate in this exciting, but very demanding, ride. Some grizzled veterans, such as Roger Plail and Andrew Etherington (80 years old next year!) will be joining us again. Peter Rimington, who led the South African challenge, will be there, but is replaced as “local knowledge team captain” by Abhay Rane, who has done a great job in recruiting and motivating participants this year. Our wonderful CEO Louise de Winter will be bravely accompanying us on the ride, as she did in Africa.

The ride commences in Bharatpur – the eastern gateway to Rajasthan. It is most famous for the Keoladeo Ghana National Park, a world heritage site and one of the finest water-bird sanctuaries in the world. On the first morning we will have a chance to visit the specacular Taj Mahal in Agra, one of the true wonders of the world.

From there, we start our adventure by cycling through the National Park. Our first day’s cycling takes us to the Bhanwar Vilas Palace in Karauli. The following day we will ride to the famous Ranthambore National Park, which is famous for its tigers; the conservation project there is popular with wildlife buffs and professional photographers from right across the world. With luck we may encounter some of the animals to be found in the park including sambar, cheetah, wild boar, leopard, jackal and hyena. We will overnight at the famous “Tiger Den”.

From here on it is just toil, sweat and tears, together with the ever-present risk of “Delhi Belly”! We will no doubt, just as we did before before, rise to the challenge and press on relentlessly to our final destination, the famous “pink city” Jaipur. Here the “Amber Fort” and a well-earned celebration awaits us.

I am very much hoping that many of you will support our endeavours with a donation, and participants themselves will add their own comments, stories and photographs to this blog. TUF is such a worthy cause, and really does an amazing job in supporting and promoting urology, not only throughout the British Isles, but in Africa and beyond. Do watch (and especially contribute to) this space! We will be posting updates to let you know how we get on.

Click here to see a short video on the challenges the TUF cyclists faced https://trendsinmenshealth.com/video/tuf-cycle-india-2016/

Roger Kirby, The Prostate Centre, London

Professor John Fitzpatrick 1948-2014

May 17, 2014/202 Comments/by Roger Kirby

Professor John Fitzpatrick 1948-2014

A Life in the Fast Lane

Wednesday morning, the 14^th May 2014, John M Fitzpatrick passed away aged 65. He left this life the way he lived it, in the fast lane. Taken ill at home in his own gym, where he was honing his fitness with his personal trainer, he was rushed by ambulance to hospital, where he died within hours from a massive subarachnoid haemorrhage. This blog in the BJUI, the journal he edited, championed and loved so very much, is a celebration of his life, and an opportunity for those who knew him to post their own special memory of him, and to contribute a tribute to one of the truly great international characters of urology.

John’s career was an illustrious one. He trained in Dublin, and then in London, where for a time he lived in a house in fashionable Chelsea, just off the King’s Road. He worked with the “greats” of British urology: John Wickham, Richard Turner-Warwick and John Blandy and was always positive and enthusiastic about his time at the famous St Peter’s Hospitals and the Institute of Urology.

Returning to his beloved Dublin, in 1986, aged 38, he successfully applied for the post of Professor of Surgery and proceeded to build up an outstanding department of urology and latterly, with the assistance of the wonderful Bill Watson, created a quite exceptional research unit. He was most proud of his international standing as possibly the world’s best-known urologist (apologies to Dr Patrick Walsh!). He certainly was the most travelled, clocking up untold millions of Air Miles in his favourite seat 2A in the British Airways First Class cabin, and a welcome guest wherever he arrived.

Things, as Richard Turner-Warwick was fond of saying, don’t just happen; they have to be made to happen. Among other things, John did sterling work in helping Bill Hendry and me to create The Urology Foundation (TUF) in 1994, by negotiating £250,000 grants from BAUS and the BJUI. He did a magnificent job as Chairman of the Scientific Committee, Trustee and Patron to help us create a thriving charity. TUF continues to do amazing work to support training and research in urology in the UK and Ireland. He adored being President of BAUS, St Peter’s medal winner and visiting professor to almost 100 academic institutions in North America.

I have too many positive memories of John to regale you with here. Climbing Kilimanjaro (he never tired of reminding me that he reached the summit well before me), trekking in Nepal, cycling in Sicily, Malawi and Madagascar. John was always “up for it”. Another boast of his was that he never misjudged people; but everywhere he went he made friends, took interest in everyone he met and communicated in his own unique, eloquent and quintessentially Irish style.

Sadly, none of us had the opportunity to say goodbye to John. He slipped away from this life, just as he did from so many international meetings, a little early, anxious to move on to the next challenge. My own particular farewell was a few weeks ago at a TUF dinner at the famous and historic Vintner’s Hall in London, where John was in his element talking to Jane MacQuitty, wine correspondent of the Times, about the merits and demerits of a variety of fine wines. With a strange prescience, he told me as he left for the airport the next day that he had enjoyed every moment of his life as a surgeon, scientist and communicator, and that always he really loved the very special world of urology.

Like me, John loved Shakespeare, so I will finish this blog with an apposite quote from the Bard:

His life was gentle, and the elements
So mixed in him that Nature might stand up
And say to all the world, “this was a man!”

When comes such another?

Farewell loyal friend Fitzy, we loved you and we will miss you badly.

Roger Kirby, The Prostate Centre, London

REGISTER FOR THE INAUGURAL JOHN FITZPATRICK IRISH PROSTATE CANCER CONFERENCE

View the programme

An interview with John M. Fitzpatrick
BJUI December 2012; Volume 110, Issue 11

Read the interview here

Click here to see a short video on the challenges the TUF cyclists in India faced https://trendsinmenshealth.com/video/tuf-cycle-india-2016/

A new treatment option for prostatitis/prostatodynia?

April 10, 2014/9 Comments/by Roger Kirby

The management of patients with chronic pelvic pain attributed to chronic prostatitis has long been rather unsatisfactory. Even prolonged treatment with an aminoquinolone, such as ciprofloxacin, and an anti-inflammatory agent, or, alternatively an alpha blocker, seldom results in rapid resolution of the symptoms, and is commonly completely ineffective.

We recently encountered a patient, effectively disabled by prostatodynia, unresponsive to standard treatment, who had been taking morphine to control the pain from 2001 – 2008. He was unable to tolerate non-steroidal anti-inflammatory analgesics. In 2008 he was prescribed initially 10 mgs, then 20 mgs daily, of the phosphodiesterase type 5 (PDE5) inhibitor tadalafil, with immediate marked improvement of his symptoms. On cessation of the medication on 4 separate occasions, his symptoms returned; recommencement of treatment each time, with 5 mgs tadalafil daily, has resulted in similar persisting improvement of his symptoms, and he has been able to discontinue treatment with morphine. As a direct consequence of the conversation with this individual we have prescribed tadalafil 5 mgs daily in several of our patients with prostatitis; so far with uniformly beneficial results. Of course, we should point out that this is an off-label indication for this medication.

However, in addition to the symptom of pelvic pain, many men suffering from chronic abacterial prostatitis/prostatodynia also complain of associated lower urinary tract symptoms and ejaculatory discomfort. Consequently treatment with tadalafil at a dose of 5 mgs per day for a period of time would seem logical. It could be surmised that many of its beneficial effects might stem from an improvement of blood flow to pelvic organs as a consequence of its anti-inflammatory and vasodilatory activity, as well as a relaxant effect on smooth muscle, as has been previously suggested in the case of lower urinary tract symptoms by Karl-Eric Andersson and others.

Clearly the hypothesis that daily treatment with a PDE5 inhibitor might be beneficial in men suffering from the prevalent condition of chronic abacterial prostatitis/prostatodynia needs to be formally tested in the context of a randomized controlled trial. If the results of such a study were to prove positive the quality of life of very many sufferers of this disorder might be significantly improved. One might also speculate that it could provide a concomitant benefit to the partners of these often very unhappy men.

Read the full BJUI article

Roger Kirby, The Prostate Centre
Culley Carson III, The University of North Carolina
Prokar Dasgupta, The Prostate Centre, Guy’s Hospital, King’s College London

Are you ready to go to prison on a manslaughter charge?

April 8, 2014/96 Comments/by Roger Kirby

Which of us fancies ending their career with a spell in the clink? Being a surgeon in the UK has just become a whole lot riskier. We all know that in our job success can add extra years to our patients lives, by contrast, failure, can result in significant harm, or, in the worst circumstances, death. We all do our best, but sometimes things don’t work out. The sentence of two and a half years in prison for Mr David Sellu, who was referred a patient who developed peritonitis after an orthopaedic operation and subsequently died, smacks of injustice, and sends a shiver down the spine of all of us surgeons, who work hard on behalf of our patients, but who cannot always guarantee success.

The case is reported in detail in the latest bulletin of the Royal College of Surgeons (Ann R Coll Surg Engl (Suppl) 2014; 96: 112-113). It appears that the main problem was a delay in taking the patient to theatre because of the difficulty in finding an anaesthetist; a problem that cannot be reasonably be blamed upon the surgeon himself. If prosecutions for manslaughter become more frequent in circumstances similar to the Sellu case, we may all have to develop new defensive strategies. Madison Branson Lawyers are experts in the area of Proceeds of Crime and Confiscation Law. The prospect of ending an otherwise unblemished career in a prison cell as a result of an unfortunate clinical mishap might deter many from entering the profession in the first place. How should we react to the very sad scenario?

Roger Kirby, The Prostate Centre, London

Welcome to the world of digital audio recordings of your consultations

March 27, 2014/19 Comments/by Roger Kirby

Has anybody ever tried to record one of your consultations? Yesterday, a patient of mine took his smartphone out of his pocket, placed it on my desk and said: “you don’t mind if I record this consultation do you doctor?” I tried not to look too surprised, gave my consent, and proceeded to go through the treatment options to him for his early prostate cancer. As I did so, perhaps a little more thoroughly and carefully than usual, I vaguely wondered whether the recording would be admissible in court or in front of the GMC if things did not go according to plan later.

By coincidence, last night I read in the BMJ a case where a patient had asked her family doctor whether she could use her smartphone to record the encounter (BMJ 2014;348g2078). Her doctor was apparently taken aback and paused to gather his thoughts. He asked the patient to put her phone away, saying that it was not the policy of the practice to allow patients to take recordings. The mood of the meeting shifted, initially jovial, the doctor had become defensive. She complied and turned off her smartphone.

As soon as the phone was turned off, the doctor raised his voice and berated her for making the request, saying that the use of a recoding device would betray the fundamental trust that is the basis of a good patient-doctor relationship. The patient tried to reason, explaining that the recording would be useful to her and her family, but the doctor shouted at her asking her to leave immediately and find another doctor.

It later transpired that the patient could prove that this had happened because she had a digital recording of the encounter. Although she had turned off her smartphone, she had a second recording device in her pocket, turned on, that had recorded every word!

According to the MDU, patients do not need their doctors’ permission to tape a consultation, as the information they are recording is personal to them and therefore exempt from data protection principles. Section 36 of the UK Data Protection Act 1998 states: “Personal data processed by an individual only for the purposes of that individual’s personal, family or household affairs (including recreational purposes) are exempt from the data protection principles and the provisions of Parts II and III”. There have taken some time to look into some of the most popular Nintendo Switch headsets on the market in an effort to help you out. Yes, it is true that there are many options out there, and it can be a chore to have to go through all of them yourself. That’s where they step in…they have done the tough work for you, and now we can present the best products reviewed on Audio Direct.

If you suspect that a patient is covertly recording you, you may be upset by the intrusion but if you act in a professional manner at all times then it should not really pose a problem. Your duty of care also means you would not be justified in refusing to continue to treat the patient. If you did, it could easily rebound on you and further damage your relationship with the patient. And, as the case described above illustrates, your refusal to continue with the consultation could easily be recorded!

Roger Kirby, The Prostate Centre, London

TUF Cycling Challenge in Southern Africa

October 28, 2013/69 Comments/by Roger Kirby

(in memory of John Anderson MS FRCS)

As most of you know, sadly John Anderson, President Elect of the British Association of Urological Surgeons, died this summer from advanced prostate cancer, which had spread to his liver (you can read John’s obituary in the BJUI and watch a video of his 2012 address to BAUS).

In his memory during the first week of November a team consisting of 30 urologists and patients are travelling to the tip of Africa for a cycling Challenge to raise funds for The Urology Foundation (TUF) (you can read more about the TUF in this BJUI Comment article). We will be cycling nearly 500 kilometres in 6 days along the Cape route, which encompasses towering mountains looming over passes hewn by hand from the rocks many years ago. We will traverse the semi-desert of the Klein Karroo on mainly dirt roads and encounter steep climbs as well as potholes and slippery patches on the ancient roads. Motorbike Sport site had provided us some awesome tips to ride at any kind of road or terrain as well. Near the coast the wind will start to play a role. The cycling gear we got online will prove to be useful. We carefully read reviews of the best gears to get from ScooterAdviser. This was and still is the Cape of Storms, and we are very likely to have to battle through a howling South Easter to reach our day’s target. Finally, we will cycle across the flats to the Southern most tip of Africa and the lighthouse at Agulhas. This, like our previous cycle challenge across the Andes, is a challenge for the fit, the tough and the stout of heart!

The funds we raise will be used to support the important work of TUF to find better treatments for kidney, bladder, prostate and testicular cancer. And, in addition, to raise awareness of bladder cancer and to train urologists in the arts of robotic, laser and laparoscopic surgery, thereby enhancing patient care. So far we have raised over £130,000. You can support us by posting a comment on this blog, or by sending a donation to TUF. We will be updating this blog with regular accounts of how our cycle challenge is progressing, so do watch this space!

Roger Kirby

Increasing importance of truly informed consent: the role of written patient information

October 21, 2013/by Roger Kirby

Roger Kirby*, Ben Challacombe*^†, Simon Hughes*^†, Simon Chowdhury*^† and Prokar Dasgupta*^†*The Prostate Centre, London W1 and ^†Guy’s and St Thomas’ NHS Foundation Trust Hospital, London, UK

Published as a comment article in BJU International 2013; 112: 715–716. doi: 10.1111/j.1464-410X.2012.11787.x

Video Commentary by Roger Kirby, BJUI Associate Editor.

Read the article

A Rather Nasty Surprise

October 8, 2013/22 Comments/by Roger Kirby

Recently, I encountered, and indeed I actually caused, a complication of robot-assisted radical prostatectomy (RARP) which was new to me, and one which I felt that I should share with other surgeons.

PM, a 60-year old teacher, underwent a completely routine RARP, which took less than 2 hours to perform on a Saturday morning. During Sunday night he developed severe abdominal pain and distension. By Monday morning he was in distress with rebound tenderness and marked tachycardia. A CT scan was requested, which revealed a caecal volvulus. A laparotomy by a general surgeon confirmed the diagnosis and an urgent right hemicolectomy was undertaken. The patient made an uneventful recovery and, I am pleased to say, is still speaking to me. Histology confirmed an ischaemic caecum twisted on its rather thickened mesentery, with no perforation present. The prostate itself contained a Gleason 3+4=7 adenocarcinoma, without evidence of extra-prostatic extension.

Although robotic assistance provides the benefits of very precise, virtually bloodless surgery, with 10 times magnification and 3D vision, it also carries the risk of a specific set of complications. These need to be dealt with promptly and efficiently and can usually be completely resolved. Failure to recognise post-operative problems, such as bowel injury, intra-abdominal bleeding or port-site hernia, however, can place the patient in severe and increasing jeopardy. We recently published an article in the BJUI entitled “Lessons Learned from 1000 robot-assisted radical prostatectomy” in which we discussed how many of the problems could be avoided, and, if they occur how they can be best dealt with. One key message is the importance of an early CT scan to diagnose the nature of a post-operative problem, rather than crossing fingers and hoping things will settle.

I am hoping that this blog, and the BJUI article mentioned above, will stimulate other surgeons to discuss openly and frankly the problems that they themselves have encountered, either with regular laparoscopy or with the da Vinci robot, and how they dealt with them. Learning the lessons, not only from one’s own errors and omissions, but also from those of others, seems the best way to become, and continue to be, a safe and successful surgeon.

Roger Kirby, The Prostate Centre, London