Dr.
Jonathan Hwang 簡介:
Dr. Jonathan J. Hwang
is a nationally recognized expert in using robotic surgery technique, which
involves tiny incisions in the body
through which small
robotic arms enter to manipulate and excise the prostate gland with utmost
precision and delicacy – a sharp contrast
to the open surgery of
yesterday. This significantly lessens blood loss and pain leading to a
faster recovery without any of the major
complications of open
surgery.
He has performed over
four hundred robotic prostatectomy cases with excellent results using the da
Vinci surgical system, manufactured
by Intuitive Surgical.
He has also established robotic surgery programs at two major medical
centers and has taught and proctored dozens
of other surgeons on
how to use this new operative modality. He is one of the few urologic
surgeons in the United States who has trained in
open, laparoscopic, and
robotic techniques with a formal fellowship in urologic oncology (cancer
specialty). He uses the newest da Vinci
model S module at
Washington Hospital Center to perform robotic surgery.
-
Dr.
Jonathan Hwang's Contact Info
-
2021 K St.,
NW, Suite 420, Washington, DC, 202 877-9460
jonathan.j.hwang@medstar.net
- Prostate cancer:
- Prostate cancer ranks
as the number one cancer risk for American man over 50. Prostate cancer is a
disease in which malignant (cancer)
- cells form in the
tissues of the prostate. The prostate is a grand in the male reproductive
system located just below the bladder and in front
- of the rectum. It is
about the size of a walnut and surrounds part of the urethra (the tube that
empties urine from the bladder). The prostate
- gland produces fluid
that makes up part of the semen. Tests that examine the prostate and blood
have been successfully used to detect and
- diagnose prostate
cancer. Available treatments include watchful waiting, surgery, radiation
treatment and hormone therapy. Treatment options
- are dependent on
various prognostic factors including age, stage, cell type (histological)
grade, and year of diagnosis.
-
- One of the most
effective treatments is the surgical removal of cancerous cells. The advent
of robotic technology into the operating room
- has breathed new life
into the age-old field of surgery. This is especially true for prostate
cancer surgery, which has jumped quantum leaps
- in the past several
years with robotic assistance – the newest form of minimally invasive
surgery.
-
Summary of Dr
Hwang
's Presentation
-
- Summarized by Edward Wan
What is the prostate gland and its
function
The prostate is a gland in the
male reproduction system located just below the bladder and in front of the
rectum. It is about the size of a walnut and
surrounds part of the urethra (the tube that empties urine from the bladder).
The prostate gland produces fluid that makes up part of the semen. As men age,
the prostate may get bigger and block the urethra or bladder. This may cause
difficulty in urination or can interfere with sexual function. The condition is
called benign prostatic hyperplasia (BPH).
What are the Symptoms of Prostate Cancers
- ·
Weak or interrupted flow of urine.
- ·
Frequent urination (especially at night).
- ·
Trouble urinating.
- ·
Pain or burning during urination.
- ·
Blood in the urine or semen.
- ·
A pain in the back, hips, or pelvis that doesn't go away.
- ·
Painful ejaculation
Tests and procedures to diagnose prostate cancers
-
·
Digital rectal exam (DRE): An exam of the rectum.
-
·
Prostate-specific antigen (PSA) test: A test that measures the
level of PSA in the blood. PSA is a substance made by the prostate that may be
found in an increased amount in the blood of men who have prostate cancer.
-
·
Trans-rectal ultrasound: A procedure in which an ultrasound
probe is inserted into the rectum to check the prostate.
-
- Potential Causes and
Prognosis of Prostate Cancers
-
·
High protein diets- high protein diets potentially cause high
risk
-
·
Antioxidants such as tomato juice, Vitamin D etc. might be
beneficial to prevent prostate cancers
-
·
Other supplements such as Vitamin E and Selenium have not proved
to be effective to prevent prostate cancers
-
·
Age and health conditions are critical factors– less risk for
men with age less than 50 and higher risk for men with age greater than 65
-
·
Race is a factor - African Americans tend to have twice as much
risk than the White Americans. Asian Americans have the lowest risk but with
high intensity prostate cancer potential
-
·
Heretic definitely is a factor – men with high risk if one’s
relative (like brother) over age 50 has prostate cancers
-
·
Prognosis depends on the Gleason score and the level of PSA –
the level of Gleason score and PSA are directly proportional to the age groups
Available Prostate
Cancers Treatments
Watchful waiting
-watchful waiting is closely monitoring a patient’s condition without giving any
treatment until symptoms appear or change. This is usually used in older men
(over age 70) with other medical problems and early- stage disease.
Radiation therapy-
radiation therapy is a cancer treatment that uses high-energy x-rays or other
types of radiation to kill cancer cells or keep them from growing. There are two
types of radiation therapy. External radiation therapy uses a machine outside
the body to send radiation toward the cancer. Internal radiation therapy uses a
radioactive substance sealed in needles, seeds, wires, or catheters that are
placed directly into or near the cancer. The way the radiation therapy is given
depends on the type and stage of the cancer being treated. Impotence and urinary
problems may occur in men treated with radiation therapy.
Hormone therapy-
hormone therapy is a cancer treatment that removes hormones or blocks their
action and stops cancer cells from growing. Hormones are substances produced by
glands in the body and circulated in the bloodstream. In prostate cancer, male
sex hormones (androgens) can cause prostate cancer to grow. Drugs, surgery, or
other hormones are used to reduce the production of male hormones or block them
from working.
-
Surgery Options -
One of the most
effective treatments is the surgical removal of cancerous cells. Patients in
good health are usually offered surgery as treatment for prostate cancer. Two
types of radical prostatectomy. In a retropubic prostatectomy, the prostate is
removed through an incision in the wall of the abdomen. In a perineal
prostatectomy, the prostate is removed through an incision in the area between
the scrotum and the anus. The most common surgical options consists of the
following:
-
-
Open Surgery-
in the old days, open surgery was the only available means to remove prostate
and the success of operation was largely dependent on surgeon’s skill and
knowledge. Since prostate gland and its associated nerve systems are deeply
imbedded inside the abdomen, sometimes the surgeon’s hands are too large to
maneuver to reach to the prostate gland.
-
- Robotic
Surgery – the advent of robotic surgery for prostatectomy in the US since
2003 has breathed new life into the age-old field of surgery. This is
especially true for prostate cancer surgery, which has jumped quantum leaps
(i.e. over 30,000 total surgeries performed in the US) in the past several
years with robotic assistance – the newest form of minimally invasive surgery.
The robotic surgery technique, which involves tiny incisions in the body
through which small robotic arms enter to manipulate and excise the prostate
gland with utmost precision and delicacy – a sharp contrast to the open
surgery of yesterday. The robotic surgery basically eliminates the
uncertainties associated with the surgeon’s hands. This also significantly
lessens blood loss and pain leading to a faster recovery without any of the
major complications of open surgery.
Dr Hwang has
performed over seven hundred robotic prostatectomy cases with excellent results
using the da Vinci surgical system, manufactured by Intuitive Surgical. Dr.
Hwang commented that in order for a surgeon to be proficient in the robotic
prostatectomy, the surgeon needs to perform close to 200 operations. He
predicted that robotic prostatectomy would continue to grow and could replace
the old-fashioned open surgery of prostactectomy in the future. The initial
investment for the robotic equipments would be high compared to conventional
surgical systems, but the life-cycle costs for the robotic surgery could be
attractive when considering the entire surgical procedures and the overall
shorter patient recovery time.
Cryo-Surgery-
cryosurgery is a treatment that uses an instrument to freeze and destroy
prostate cancer cells. This type of treatment is also called cryotherapy.
Impotence and leakage of urine from the bladder or stool from the rectum may
occur in men treated with cryosurgery.
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