WEBVTT 00:00:00.000 --> 00:00:09.740 Welcome to Self Regional's Medically Speaking Podcast. 00:00:09.740 --> 00:00:13.100 Today we have a special guest with us, Dr. Todd Hanson. 00:00:13.100 --> 00:00:20.440 Todd is one of our new urologists that just joined our practice about a year ago and is 00:00:20.440 --> 00:00:23.000 also a very skilled robotic surgeon. 00:00:23.000 --> 00:00:27.280 So in today's episode, we'll be learning a little bit about Todd and the surgeries that 00:00:27.280 --> 00:00:33.900 he does, and a little bit about robotic surgery in general. So with that, Todd, thanks for joining 00:00:33.900 --> 00:00:38.340 me today. And just maybe tell us a little bit about your background, where you're from, and 00:00:38.340 --> 00:00:42.600 how you ended up in Greenwood. Well, thanks for inviting me to be part of your podcast. 00:00:42.600 --> 00:00:51.180 Originally, I grew up in Arizona, and my wife is from New Mexico. And we met at undergrad. 00:00:51.180 --> 00:00:59.760 and coming out of residency we practiced in Wyoming for 17 years and then you recruited us 00:00:59.760 --> 00:01:05.460 away to to come up here to Greenwood and join Greenwood and we've had a fantastic experience and 00:01:05.460 --> 00:01:13.040 so I come with with four kids in tow and two that are in college so we've had a great experience for 00:01:13.040 --> 00:01:18.040 our family and they've been very welcomed here. Oh good to hear well we're certainly glad to have 00:01:18.040 --> 00:01:22.040 you here. That's for sure. I know our community is blessed to have you as well and the skill set 00:01:22.040 --> 00:01:27.660 that you bring. So let's just talk a little bit about robotic surgery in general. And maybe you 00:01:27.660 --> 00:01:33.000 can just give me the background a little bit on robotics and how it kind of evolved and kind of 00:01:33.000 --> 00:01:39.340 the type surgeries that we do today as compared to where it started. Sure. That's kind of an 00:01:39.340 --> 00:01:45.720 interesting story. The robotics was actually primarily developed, as I understand it, 00:01:46.260 --> 00:01:52.640 via NASA and the military, and they were looking at ways of kind of doing some remote surgery and 00:01:52.640 --> 00:01:58.800 things like that. And they developed the technology, which at the time wasn't working 00:01:58.800 --> 00:02:04.560 out real well for them. So they ultimately sold it to a company called Intuitive. And Intuitive 00:02:04.560 --> 00:02:10.120 picked up and kind of became the forefront in robotics. There's other robotic surgeries out 00:02:10.120 --> 00:02:18.040 there but uh for intra-abdominal surgery they really um are the only fda approved uh company 00:02:18.040 --> 00:02:24.900 that has a robot that's used for that and um so they they sold the technology to intuitive and 00:02:24.900 --> 00:02:32.000 were didn't really know quite where the home was and as they were going around seeing some 00:02:32.000 --> 00:02:38.080 different surgeons there was a urologist in texas and they were actually there to to market it to 00:02:38.080 --> 00:02:43.320 the cardiothoracic surgeons but the urologist was doing laparoscopic prostates and he said hey 00:02:43.320 --> 00:02:50.800 I think I could use this doing prostates and so it was an exceptional tool for doing that 00:02:50.800 --> 00:02:58.440 and so it really quickly took off primarily in urology and then as the technology evolved and 00:02:58.440 --> 00:03:04.860 people got better at it and learned how to apply it more than it really farmed into a lot of the 00:03:04.860 --> 00:03:11.860 other fields and so that's how it it kind of got started that was actually relatively recently it 00:03:11.860 --> 00:03:21.020 was early 2000s that that the first prostatectomy was performed by 2005 as I was coming out of 00:03:21.020 --> 00:03:27.500 residency it was really starting to become a little more of a popular thing where people 00:03:27.500 --> 00:03:35.880 were starting to train on it and i started um first doing robotics in 2007 so um in the spectrum 00:03:35.880 --> 00:03:43.300 of things it's still relatively new gotcha so what are some advantages of say robotic surgery 00:03:43.300 --> 00:03:50.580 versus the traditional either open or laparoscopy surgery yeah so it it allows you to do 00:03:50.580 --> 00:03:56.840 procedures laparoscopically that you just can't traditionally do laparoscopically and so 00:03:56.840 --> 00:04:02.880 obviously the advantage of doing something laparoscopically first and foremost is you 00:04:02.880 --> 00:04:08.880 have a lot smaller incisions which equates to typically a quicker recover and a lot less pain 00:04:08.880 --> 00:04:14.620 and then if you have to do an open procedure if you do a nephrectomy or remove a kidney 00:04:14.620 --> 00:04:19.520 you might end up with a large incision traditionally from from the middle of your 00:04:19.520 --> 00:04:24.560 sternum off over to the side versus if you're doing it laparoscopically you can use several 00:04:24.560 --> 00:04:32.780 small incisions. And so it's allowed us to transition many surgeries, which had to be 00:04:32.780 --> 00:04:39.900 done open because of the constraints of typical laparoscopy and to then do them laparoscopically. 00:04:39.900 --> 00:04:47.180 So the technology behind that is primarily that the instruments are wristed. When you do 00:04:47.180 --> 00:04:53.360 general laparoscopy, you're stuck with a straight instrument that goes into the body 00:04:53.360 --> 00:04:59.860 and you can open and close it but there's no wristed action and and with a robot you've got 00:04:59.860 --> 00:05:06.480 a wristed instrument that then makes things like suturing and dissecting much more natural and much 00:05:06.480 --> 00:05:13.340 more easy whereas before it was very very difficult it also improves things like your 00:05:13.340 --> 00:05:19.920 dexterity and and even your visualization becomes much much better because rather than looking at 00:05:19.920 --> 00:05:25.740 things that you know maybe as you're standing up in an open procedure is a really tough angle you 00:05:25.740 --> 00:05:30.780 can actually take your scope right down where you're working and see it up close and and get 00:05:30.780 --> 00:05:37.000 very good visualization of course all that ultimately equates to just better outcomes so 00:05:37.000 --> 00:05:42.740 in the short term you think well you get a lot less pain and discomfort potentially but 00:05:42.740 --> 00:05:49.260 lots of times even more importantly you just get better surgery because for example if you're 00:05:49.260 --> 00:05:55.220 doing a prostatectomy and you're trying to sew the urethra back up to the bladder your your 00:05:55.220 --> 00:06:01.460 visualization your better your ability to do a nice watertight anastomosis is just really enhanced 00:06:01.460 --> 00:06:08.160 or if you're you know trying to spare critical structures like the nerves you can just you see 00:06:08.160 --> 00:06:14.420 and do a lot better because your your handling of the tissue is a lot finer and it's like you're 00:06:14.420 --> 00:06:20.340 working at it almost under a microscope rather than from a far distance with your with your big 00:06:20.340 --> 00:06:26.920 paws in there pushing things around for sure you're a big guy like me with big hands and uh 00:06:26.920 --> 00:06:31.860 definitely can get in there a lot tighter with the with the robot than you can with big hands 00:06:31.860 --> 00:06:36.980 that's for sure well no that's good information and then um also just thinking about the future 00:06:36.980 --> 00:06:42.400 of robotics what what are you uh what do you see kind of going forward like the next five or ten 00:06:42.400 --> 00:06:48.460 years and for future developments for robotic surgery? Yeah, that's a great question. So I think 00:06:48.460 --> 00:06:53.100 the real answer is none of us really know for sure where all it's going to lead. But there's some 00:06:53.100 --> 00:07:01.340 paths that are becoming rather evident. Number one, they're changing the nature of a lot of the 00:07:01.340 --> 00:07:09.960 robots. For example, currently, you can use a robot that is kind of like doing a colonoscopy, 00:07:09.960 --> 00:07:15.820 except at the end of the scope, you would have two instruments that come out, 00:07:15.820 --> 00:07:19.020 so like a needle driver and some scissors. 00:07:19.020 --> 00:07:29.400 And rather than having an open colon surgery to remove a polyp that's too big to treat with colonoscopy, 00:07:29.400 --> 00:07:37.900 either the colorectal surgeon or the gastroenterologist can actually make a full thickness cut in the bowel, 00:07:38.160 --> 00:07:45.720 remove the polyp and then have the ability to sew it back up from inside the lumen and that's not 00:07:45.720 --> 00:07:51.080 real popular as of yet but but that would definitely be a that's something that's been done 00:07:51.080 --> 00:07:56.460 and is being done they also have robots in a similar fashion that can do the same thing in 00:07:56.460 --> 00:08:03.580 the lungs where you it actually you're mirroring the technology so you're taking pre-operative 00:08:03.580 --> 00:08:09.740 imaging and you're mirroring it onto the robot and you actually know where to go. You have a 00:08:09.740 --> 00:08:15.080 roadmap as to where to go to go find the lesion. So rather than just having all of these, you know, 00:08:15.080 --> 00:08:19.540 different bronchi with different branches and not knowing which one's going where and just having to 00:08:19.540 --> 00:08:24.760 go down this one and this one and this one, you mirror the technology such that the robot says 00:08:24.760 --> 00:08:30.520 turn left and turn right. And it's kind of like you have a GPS for the lung lesion. So you take 00:08:30.520 --> 00:08:36.240 your CT your preoperative imaging and you mirror it into the robot and it then begins to tell you 00:08:36.240 --> 00:08:42.540 which turn to take where to find the lesion and then it has instruments that come out just like 00:08:42.540 --> 00:08:50.220 from the colonoscopy and allows you to do the biopsy via the that so those would be two another 00:08:50.220 --> 00:08:57.980 area that it's expanding rapidly is now that is actually remote surgery the one of the big hang 00:08:57.980 --> 00:09:03.940 ups with remote surgery has been that the actual time delay that it takes for the information to 00:09:03.940 --> 00:09:11.260 transmit. So if I'm moving an instrument and I'm many miles away, there's a bit of a time delay 00:09:11.260 --> 00:09:17.360 between how it moves and how I see it move. And they actually know the exact time. I don't remember 00:09:17.360 --> 00:09:22.760 what it is, but you have to get your times lower than that or it becomes a very unnatural surgery. 00:09:23.580 --> 00:09:28.640 And now with the 5G internet and some of the technologies coming down with the internet, 00:09:28.640 --> 00:09:34.440 they're actually breaking that barrier such that remote surgery is becoming. 00:09:34.440 --> 00:09:38.720 They have done it, but it's somewhat difficult and complicated. 00:09:38.720 --> 00:09:42.160 But they're actually getting to the point where they're breaking the barriers, 00:09:42.160 --> 00:09:46.160 where remote surgery is going to become a very real thing, 00:09:46.160 --> 00:09:52.380 where your surgeon that primarily does the surgery may be in a completely different state 00:09:52.380 --> 00:10:00.340 and even completely different country and still be able to to do the surgery with an assistant 00:10:00.340 --> 00:10:06.020 who's probably a surgeon but maybe just doesn't do that exact surgery yeah that's really interesting 00:10:06.020 --> 00:10:10.480 i can remember when i was in medical school even that was like i think kind of the dream right so 00:10:10.480 --> 00:10:15.820 like say someone in the u.s military was in some type of a condition in another country in another 00:10:15.820 --> 00:10:19.960 part of the world and a surgeon in the united states would operate them on on them remotely 00:10:19.960 --> 00:10:23.940 but it sounds like the speed of which the communication happened 00:10:23.940 --> 00:10:25.580 was a barrier that may be getting solved. 00:10:25.580 --> 00:10:26.420 That's real interesting. 00:10:26.420 --> 00:10:31.280 Yeah, and my understanding is it's the Internet speed. 00:10:31.280 --> 00:10:39.680 And I guess from what I have been told at meetings and things like that 00:10:39.680 --> 00:10:44.200 by people who understand this much better and experts they bring into the field, 00:10:44.200 --> 00:10:48.520 that that's quickly starting to become a real reality. 00:10:48.780 --> 00:11:18.100 The other technology that's really coming up is, again, the ability to kind of mirror, to use multiple technologies, like to have a 3D recreation of maybe a kidney in the tumor and to have that mirrored onto the screen that you're using to operate such that the programming, they have artificial intelligence such that it's, you know, 00:11:18.100 --> 00:11:24.540 you can see where the tumor is um based on the pre-operative imaging and that's getting portrayed 00:11:24.540 --> 00:11:31.300 to your screen while you're operating so that it makes a bit of a roadmap for the surgeons and 00:11:31.300 --> 00:11:38.820 that that's actually coming you know that that's not too far away they're they're kind of there's 00:11:38.820 --> 00:11:44.620 a lot of formats developing along that line and i would be shocked but what some of the newer 00:11:44.620 --> 00:11:49.940 versions of the robots that are coming out don't have some of these other technologies but 00:11:49.940 --> 00:11:56.000 you know much like a lot of technologies you don't exactly know where it's headed until it hits you 00:11:56.000 --> 00:12:03.800 because it develops so rapidly but there's um robotic surgery both in 00:12:03.800 --> 00:12:11.640 um intra-abdominal surgery and elsewhere is just really taking off because we've just found that 00:12:11.640 --> 00:12:18.740 you know, we, we can find ways to use machines to be more precise in, in what we do. 00:12:18.740 --> 00:12:24.040 Gotcha. Well, let's switch gears just a little bit. I just want to talk about urology 00:12:24.040 --> 00:12:29.020 just for a few minutes. Um, and so like, uh, just in Greenwood and your time here, 00:12:29.020 --> 00:12:36.040 what are some of the common conditions that you see in our population? Um, and, um, and like I 00:12:36.040 --> 00:12:38.080 So what are the treatments for those common conditions? 00:12:38.080 --> 00:12:42.900 Yeah, so I think it's very similar to other populations. 00:12:42.900 --> 00:12:46.160 I mean, what are common urological conditions? 00:12:46.160 --> 00:12:50.480 Kidney stones is probably one of the most common. 00:12:50.480 --> 00:12:55.160 Enlarged prostates that need to be treated. 00:12:55.160 --> 00:13:00.860 Incontinence, you know, female incontinence. 00:13:01.860 --> 00:13:12.560 Female prolapse, where you're having difficulty with your bladder and uterus kind of falling down and falling out. 00:13:12.560 --> 00:13:22.760 Boy, you know, cancers, bladder cancer, prostate cancer, kidney cancer, kind of up and down the spectrum. 00:13:22.760 --> 00:13:30.320 You know, I think just there's a lot of general urology here and a lot to be done. 00:13:30.320 --> 00:13:35.260 And I don't know that it's so unique here as it is anywhere else. 00:13:35.260 --> 00:13:42.000 Although if you look at a map of what they call the stone belt, we're right in the center of that. 00:13:42.000 --> 00:13:50.760 And so kidney stones are probably one of the more popular issues that the higher incidence here than a lot of areas in the in the country. 00:13:50.760 --> 00:13:56.260 But short of that, there's just there's just plenty of urology to go around. 00:13:56.760 --> 00:14:01.400 Yep. Oh yeah. So like, um, you know, common things like the kidney stones don't necessarily 00:14:01.400 --> 00:14:05.900 require a robot. They're treated differently, but some conditions do require robotic surgery. 00:14:05.900 --> 00:14:10.560 What, like, what are the conditions that do require robotic surgery, for example, in urology? 00:14:10.560 --> 00:14:17.420 That's a great question. So, um, we use it with almost all the cancers, you know, 00:14:17.420 --> 00:14:24.220 um, so prostate cancer, uh, prostatectomies, that's probably one of the cornerstones to, 00:14:24.600 --> 00:14:32.060 the procedures that we do. Cancer in the ureters that drain urine from the kidney down to the 00:14:32.060 --> 00:14:39.880 bladder, we would use it there to maybe remove part of a ureter and then reimplant the rest of 00:14:39.880 --> 00:14:46.260 the ureter up into the bladder. Bladder cancer, that's probably one of the biggest procedures we 00:14:46.260 --> 00:14:53.740 do with it, where we will remove an entire bladder with the robot and then reconstruct it using a 00:14:53.740 --> 00:15:01.240 piece of bowel to divert it and do lymph node dissections all at one shot. Kidney cancers. So 00:15:01.240 --> 00:15:07.940 many, most of the kidney cancers are now caught thanks to our lovely ER doctors and all the CT 00:15:07.940 --> 00:15:15.800 scanning. You know, they find them much smaller now. And so I'd say the majority of the kidney 00:15:15.800 --> 00:15:21.160 cancers that come in, we can actually treat just by removing the part of the kidney that has the 00:15:21.160 --> 00:15:27.800 cancer in it without having to remove the entire kidney and that would be a very common procedure 00:15:27.800 --> 00:15:35.480 that we do robotically and as well as removing the entire kidney and then you know there's several 00:15:35.480 --> 00:15:42.320 benign issues as well maybe scarring in the ureter where we have to to kind of bypass the scarring 00:15:42.320 --> 00:15:49.680 or even a simple prostatectomy where we're not removing the prostate for cancer but we're 00:15:49.680 --> 00:15:56.680 removing it for, for enlargement, um, you know, issues like that, that come up that we also use 00:15:56.680 --> 00:16:02.680 it for. Um, those would probably be the primary, um, procedures that we do with it. 00:16:02.680 --> 00:16:07.520 Yeah. So prostate enlargement, I think that's something pretty much every man's going to have 00:16:07.520 --> 00:16:14.400 to deal with at some point, right? Many of them will. Yes. Fortunately, most of them can be 00:16:14.400 --> 00:16:19.680 managed with medication. And then there's some that progress to surgery, such as maybe 00:16:19.680 --> 00:16:26.020 doing a laser or something actually via the urethra. But there's a small portion that 00:16:26.020 --> 00:16:32.620 progress to needing a bigger surgery to actually treat it. But most of them, gratefully, we can 00:16:32.620 --> 00:16:38.600 treat with even more minor things. Yeah. Yeah, absolutely. So another thing that you and I have 00:16:38.600 --> 00:16:43.720 spoken about before that is, um, maybe either unrecognized or maybe just not being treated 00:16:43.720 --> 00:16:49.760 in a large extent here in our community is like urinary incontinence in women. Um, let's talk 00:16:49.760 --> 00:16:54.000 about urinary incontinence in women for just a second. And like some of the treatments that are 00:16:54.000 --> 00:16:59.060 available for that. Yeah. Thanks for reminding me about that. Um, so, so there's two different 00:16:59.060 --> 00:17:06.000 issues that kind of go along. Um, one is prolapse, um, where, you know, basically you have a hernia 00:17:06.000 --> 00:17:13.480 of the vagina right things are starting to fall down and fall out and um the robot actually 00:17:13.480 --> 00:17:20.060 provides a great avenue for that because probably the best procedure for for a lot of those patients 00:17:20.060 --> 00:17:28.140 is to suspend the the vagina back up um using a piece of mesh and securing it to the sacrum 00:17:28.140 --> 00:17:34.460 and and we can do that laparoscopically using a robot rather than doing an open procedure like 00:17:34.460 --> 00:17:41.840 when i first learned to do it um and so that you know female reconstruction um is actually a large 00:17:41.840 --> 00:17:49.720 portion of what we do with the robot and then kind of along those same lines um although a 00:17:49.720 --> 00:17:56.400 separate problem is the leakage of urine and lots of times women will will develop a stress 00:17:56.400 --> 00:18:03.880 incontinence because um and have prolapse and so both need to be fixed but not everyone who 00:18:03.880 --> 00:18:09.720 has stress incontinence necessarily has to have prolapse procedure and not everyone who has a 00:18:09.720 --> 00:18:17.720 prolapse procedure needs to have stress incontinence surgery either but to to fix a stress incontinence 00:18:17.720 --> 00:18:24.160 where you leak when you giggle or or run or cough we we use a small piece of mesh underneath the 00:18:24.160 --> 00:18:29.900 urethra called a mid urethral sling and that's probably the most common procedure to treat that 00:18:29.900 --> 00:18:36.200 and all of those are we can do very well here and are very skilled at and then you get into the 00:18:36.200 --> 00:18:41.700 other types of incontinence um again if we're just on the female side then you're talking about you 00:18:41.700 --> 00:18:49.960 know urgency and frequency which primarily would be treated with medication and and and and also 00:18:49.960 --> 00:18:54.840 you can have an overflowing continence you know and that would need to be addressed in other ways 00:18:54.840 --> 00:19:19.540 And part of the beauty is we've also, South Regional Hospital has invested in the equipment that allows us to now sort that out in clinic with a fairly easy study that allows us to do the right studies and get the right answers so that we're treating the right problem in the correct way. 00:19:19.540 --> 00:19:26.720 I don't want to try and continue to treat a stress incontinence with medications and vice versa. 00:19:26.720 --> 00:19:33.020 I don't ever want to take someone who has an urge incontinence and do surgery because that's not going to do them any good either. 00:19:33.020 --> 00:19:45.800 And so we've made some big investments in bringing in the right equipment to allow us to make the right diagnosis and then also perform the right treatments. 00:19:45.800 --> 00:19:53.520 and so that almost spans the the gamut of female reconstruction um there there are some other small 00:19:53.520 --> 00:19:59.820 things but that's probably the the overwhelming majority of patients would would be able to get 00:19:59.820 --> 00:20:08.660 treated and fixed and and dealt with um here in in really the most um the most up-to-date manner 00:20:08.660 --> 00:20:15.340 that that's out there you know it's not like we're having to use old techniques or um really 00:20:15.340 --> 00:20:21.200 the most up-to-date therapy that exists yeah and that's one thing todd that i know our community 00:20:21.200 --> 00:20:25.060 really appreciates you being here and some of the advanced procedures that you bring it's a it's a 00:20:25.060 --> 00:20:31.420 big deal it's uh i hear it weekly where someone's just really glad to be able to offer those 00:20:31.420 --> 00:20:35.700 services and i've said it before i'm sure you've heard me say it too um one of our big goals here 00:20:35.700 --> 00:20:40.320 is to be able to provide as high level of service here in greenwood itself regional as you can get 00:20:40.320 --> 00:20:45.280 anywhere as you can get in Atlanta or Charlotte or Casper, Wyoming, or anywhere else for that 00:20:45.280 --> 00:20:50.140 matter. And, um, we appreciate, uh, the services that you're bringing to allow us to be able to 00:20:50.140 --> 00:20:54.240 do that in the field of urology, uh, and with your partners. So we definitely appreciate that. 00:20:54.240 --> 00:21:00.440 Um, I thought we might touch on just for a second, um, just because I know a lot of men out there 00:21:00.440 --> 00:21:05.680 have questions about prostate cancer, just specifically like when should someone start 00:21:05.680 --> 00:21:10.580 getting screened for prostate cancer. What are signs of prostate cancer? Just some, maybe just 00:21:10.580 --> 00:21:14.580 talk about that for a little bit. Yeah, that's a great question. Regrettably, by the time you get 00:21:14.580 --> 00:21:21.680 signs, it's kind of the cat's out of the bag, as is the case with many cancers. You don't really 00:21:21.680 --> 00:21:28.160 want to wait until you have signs. So screening recommendations, if you have a strong family 00:21:28.160 --> 00:21:34.960 history, it's probably wise to start checking a PSA, which is still considered kind of the best 00:21:34.960 --> 00:21:40.960 screening methods. So a PSA, I should back up a little bit. A PSA is just a blood test, 00:21:40.960 --> 00:21:47.300 prostate specific antigen. It's a protein made by the prostate that's unique to just prostate tissue. 00:21:47.300 --> 00:21:53.880 And when that's elevated, sometimes, not always, but sometimes that can be because you have 00:21:53.880 --> 00:22:01.100 prostate cancer. And so generally, if you've got a strong family history, it would be wise to start 00:22:01.100 --> 00:22:07.080 screening when you're 40. If you do not have a strong family history, then our typical 00:22:07.080 --> 00:22:13.000 recommendations would be from the age of 50 to 70. And sometimes we cheat a little bit and in 00:22:13.000 --> 00:22:20.300 the real healthy males, we'll go up to 75 or so to screen for it. Interestingly, and what's 00:22:20.300 --> 00:22:30.800 sometimes difficult for a lot of both providers and, excuse me, both providers and patients to 00:22:30.800 --> 00:22:35.380 understand is actually sometimes you start getting older and you're still screening and 00:22:35.380 --> 00:22:40.640 you're actually doing yourself more harm than good. And that's a whole nother complex story. 00:22:40.640 --> 00:22:45.940 But that's why we limit it. That's why we cut it off is you can actually get to a point where 00:22:45.940 --> 00:22:52.920 you're causing more difficulties than benefit. So I remember you asking about screening. I think 00:22:52.920 --> 00:22:57.880 there were some other things in your question. You're going to have to remind me. So screening 00:22:57.880 --> 00:23:04.660 from 40 to or from 50 to 70 for those that are not of high risk for those that are of high risk 00:23:04.660 --> 00:23:11.360 age 40 to 70 would be your recommendations and the screening would consist of a blood test being a psa 00:23:11.360 --> 00:23:20.020 sure so if someone's psa comes back elevated what's what's the next step yeah i mean so um 00:23:20.020 --> 00:23:25.100 you know like much things you have to kind of interpret the elevation right so 00:23:25.100 --> 00:23:32.680 someone who has a chronically elevated PSA and it's just over the baseline and you're a little 00:23:32.680 --> 00:23:39.520 older, you may choose to watch that and have a discussion about that. Obviously, the younger 00:23:39.520 --> 00:23:45.500 you are, the more excited we're going to be or the larger the change. And so if there's a 00:23:45.500 --> 00:23:51.520 significant change, we would typically recommend proceeding with a prostate biopsy where we do an 00:23:51.520 --> 00:24:00.280 ultrasound in clinic and then actually numb it up and then obtain tissue to look at. At the same 00:24:00.280 --> 00:24:06.460 time, the other thing that is frequently done is an MRI of the prostate that can help us. And 00:24:06.460 --> 00:24:12.760 you can have a debate as to whether to do that first, or I think most of the world is settling 00:24:12.760 --> 00:24:18.300 on the fact that we should do a biopsy. And then if it becomes more of a question after a negative 00:24:18.300 --> 00:24:24.320 biopsy, you would then consider doing an MRI of the prostate to look at there. There are other 00:24:24.320 --> 00:24:29.500 markers. There's actually lots of other markers out there that can sometimes give some added 00:24:29.500 --> 00:24:37.080 information, but primarily PSA is still the best thing to do. And then biopsy and or an MRI. 00:24:37.080 --> 00:24:45.380 Gotcha. And then I guess if you make the firm diagnosis with tissue biopsy and or imaging 00:24:45.380 --> 00:24:50.380 studies than perhaps prostatectomy or there's other treatment options as well for prostate 00:24:50.380 --> 00:24:55.420 cancer? Yeah, absolutely. So the latter, there's lots of treatment options. The first thing to 00:24:55.420 --> 00:25:01.680 understand is actually we've come to realize in the medical community and urology specifically 00:25:01.680 --> 00:25:05.260 that there's a lot of prostate cancers we just don't need to treat at all, 00:25:05.260 --> 00:25:13.700 that they are low grade and that we can safely follow them. And if they begin to meet criteria 00:25:13.700 --> 00:25:18.820 for needing treated we can treat then and actually not have any worse of an outcome and that's now 00:25:18.820 --> 00:25:23.760 been shown in many studies there was a great study just came out of europe in the european journal 00:25:23.760 --> 00:25:29.900 that looked at several thousand men and again confirmed this exact same strategy that we've 00:25:29.900 --> 00:25:35.380 started practicing more and more and more so not every prostate cancer even needs treated and then 00:25:35.380 --> 00:25:40.820 you kind of get into well let's say they do they do meet criteria for needing treatment 00:25:40.820 --> 00:25:49.880 And then your two main therapies would either be surgical removal via prostatectomy or radiation. 00:25:49.880 --> 00:25:59.300 There are other treatments out there, but those are the two main treatments that are kind of the most time-proven and shown to be the most effective. 00:25:59.300 --> 00:26:03.960 Todd, tell us how you keep up with the latest advances in urology and your specialty. 00:26:03.960 --> 00:26:07.780 Yeah, that's a very interesting question. 00:26:08.780 --> 00:26:13.900 I'd always heard physicians talk about how you've really got to stay up to date in your profession. 00:26:13.900 --> 00:26:22.740 And if I was really honest training, I always wondered if I would be one of those surgeons and physicians that was able to stay up to date. 00:26:22.740 --> 00:26:26.560 And you would kind of hear about the importance of that. 00:26:26.560 --> 00:26:38.280 And yet, as I look back, I realize that that's actually been the biggest key to me having a lot of success in my career is my willingness to kind of stay up to date. 00:26:38.280 --> 00:26:53.300 You walk a fine line, honestly. You don't want to embrace every technology. There's lots of technologies that come by that don't end up being as good as what are initially promised. And you don't want to just embrace technology to embrace technology. 00:26:53.600 --> 00:27:00.940 On the other hand, you don't want to miss out on kind of improving your skills and making sure that you're up to date. 00:27:00.940 --> 00:27:04.720 So what are things that I do personally to try and stay up to date? 00:27:04.720 --> 00:27:07.760 I mean, obviously, we go to a lot of national meetings. 00:27:07.760 --> 00:27:09.840 That helps tremendously. 00:27:09.840 --> 00:27:16.720 You have to invest the time in that and the time to learn at national meetings. 00:27:17.100 --> 00:27:23.800 Some of it is done via, you know, reading journal articles and and and things like that. 00:27:23.800 --> 00:27:31.160 And and at other times, it's just having a need and saying, how am I going to do it? 00:27:31.160 --> 00:27:38.440 And and and figuring it out and reading and and kind of continuing to push yourself. 00:27:38.440 --> 00:27:59.940 And so, um, you know, that's my career has, has gone in directions that I never would have anticipated. And the technology that I've, I've embraced along the way has, has been immense, but it, it comes with, with some commitment and work as a, as a surgeon and physician. 00:27:59.940 --> 00:28:08.880 I mean, you've probably heard me say this, but when I started doing robots at first, I mean, I would record every single one of my cases. 00:28:08.880 --> 00:28:14.600 So one of the beautiful things about robotics, actually, is it's very easy for everybody to see what's going on. 00:28:14.600 --> 00:28:16.900 You can record your cases. You can send them around. 00:28:16.900 --> 00:28:22.340 I can sit down and watch the very best surgeons and how they do it, and then I can learn that. 00:28:22.340 --> 00:28:25.440 And so the learning curve has really changed dramatically. 00:28:25.440 --> 00:28:40.620 It used to be, you know, you'd watch another surgeon do a case, and you were lucky if you could see half of what they could see, and there was no real great way to record it or to share it, whereas here you can actually record cases, you can have other people look at it, you can look at it yourself. 00:28:40.620 --> 00:28:46.320 it's really revolutionized how we learn to do a lot of surgeries. You can go to courses where, 00:28:46.320 --> 00:28:52.640 you know, they, you have the experts just teach you how to do these things. And then you can take, 00:28:52.640 --> 00:28:57.840 you know, I would take every single case I did and just sit down and watch it like two or three times 00:28:57.840 --> 00:29:03.840 and go through every step I took. And, you know, what went well here? What went bad here? You know, 00:29:03.840 --> 00:29:09.160 how could I improve that? How could I make that a little slicker next time? And that takes a lot 00:29:09.160 --> 00:29:16.860 of effort. And I always hope that as physicians come along and they're doing this, they take the 00:29:16.860 --> 00:29:22.140 time to kind of put that type of work in, because I know for certain it makes a huge difference in 00:29:22.140 --> 00:29:28.500 your skills. You do get to a point where I don't know that you have to do that every time or that, 00:29:28.500 --> 00:29:35.020 but even now, you know, these images are available such that you can go back and if you have a case 00:29:35.020 --> 00:29:37.600 that maybe doesn't go quite the way you were anticipating, 00:29:37.600 --> 00:29:40.380 you can go back and look and review and say, 00:29:40.380 --> 00:29:42.280 okay, what did I do well here? 00:29:42.280 --> 00:29:45.380 Or you can have other surgeons look at it as well 00:29:45.380 --> 00:29:48.140 and say, you know, maybe you should have tried this, 00:29:48.140 --> 00:29:48.860 maybe this works. 00:29:48.860 --> 00:29:50.700 And then most importantly, you know, 00:29:50.700 --> 00:29:54.320 you learn to do it and then you go and watch. 00:29:54.320 --> 00:29:58.520 I still periodically pull out other people's videos 00:29:58.520 --> 00:30:00.640 or go to conferences and watch them and say, 00:30:00.640 --> 00:30:03.200 gosh, what are they doing a little bit differently? 00:30:03.200 --> 00:30:10.500 you know what what have they found that works better because to to be to not think that there's 00:30:10.500 --> 00:30:15.380 not other people out there that that don't you know learn other tricks along the way you're 00:30:15.380 --> 00:30:20.700 crazy you know the reason this has developed so quickly and become so good is because people have 00:30:20.700 --> 00:30:27.900 been very good about sharing and and and and demonstrating their various advancements as 00:30:27.900 --> 00:30:34.300 they make them and so that's allowed the entire urological community to really move ahead um 00:30:34.300 --> 00:30:40.000 because they you know you you're not the only one coming up with new tricks you know um the 00:30:40.000 --> 00:30:46.260 communication and the ability to integrate is is just immense and and not only can you can they 00:30:46.260 --> 00:30:52.780 describe them to that you verbally they can also um you know you can actually watch how they do it 00:30:52.780 --> 00:30:55.120 which is just a real game changer. 00:30:55.120 --> 00:30:58.580 And even one of my favorite lectures that I'd frequently go to 00:30:58.580 --> 00:31:04.060 was a urologist out of Washington University in St. Louis. 00:31:04.060 --> 00:31:08.220 And he actually has a whole lecture he gives. 00:31:08.220 --> 00:31:09.840 I've watched him give it two or three times. 00:31:09.840 --> 00:31:13.860 I forget the name of it, but he shows you all the things he's done wrong. 00:31:13.860 --> 00:31:16.640 And that's also really helpful, honestly. 00:31:16.640 --> 00:31:20.900 And he says, you know, you might get the idea to want to do this, 00:31:20.900 --> 00:31:26.160 let me show you what happens when you do. And so, you know, he goes back and he takes videos 00:31:26.160 --> 00:31:32.880 of complications and says, look at, you know, look at where I made a mistake and, and look at what 00:31:32.880 --> 00:31:38.880 caused these complications and what this led to. And, um, it just great information, you know, 00:31:38.880 --> 00:31:43.960 because we, we learn not only from other people's success, but you, you have the opportunity to 00:31:43.960 --> 00:31:49.940 learn from their, from their mistakes and that they're so open and willing to, to share that 00:31:49.940 --> 00:31:56.480 and to be upfront about it, I think is really a game changer that that exists and that people do 00:31:56.480 --> 00:32:03.140 that. Yeah, that's awesome. I mean, what a no better way to learn, right? You know, to me, 00:32:03.140 --> 00:32:07.800 that's kind of the difference between a good surgeon and an excellent surgeon, right? It's 00:32:07.800 --> 00:32:13.560 taking that time and to put in that work to really hone those skills and to watch and learn from 00:32:13.560 --> 00:32:20.300 others mistakes and and also their successes so i commend you for that that's awesome um is there 00:32:20.300 --> 00:32:25.460 anything else today todd you might want to share with our listeners again folks from out around the 00:32:25.460 --> 00:32:32.880 community maybe watching or hearing this yeah i don't know i i think primarily i just um incredibly 00:32:32.880 --> 00:32:38.800 grateful to the self regional hospital the investments they've made the sacrifices they've 00:32:38.800 --> 00:32:47.000 made, I think that there's a very strong desire from the very top up to try and make sure that 00:32:47.000 --> 00:32:53.500 we're providing a very high quality service to the community. I felt that as a physician, 00:32:53.500 --> 00:33:00.700 and I think the patients benefit from that on a routine basis. And I think the only thing is that 00:33:00.700 --> 00:33:06.980 I would say is I actually think, I think most patients would actually be surprised at the level 00:33:06.980 --> 00:33:13.020 what care they're getting. It probably gets taken for granted because you don't really recognize 00:33:13.020 --> 00:33:19.920 what level you're really getting. You just think, well, this is just the way they do it and this is 00:33:19.920 --> 00:33:27.820 the way it is and everybody's doing this. But I actually think most patients would be incredibly 00:33:27.820 --> 00:33:36.960 surprised at the high level of care and the high level of the equipment and the training and the 00:33:36.960 --> 00:33:44.160 staff that we have i it probably gets taken for granted not intentionally but it probably gets 00:33:44.160 --> 00:33:50.960 taken for granted a little bit and i just think self has made a tremendous commitment to to make 00:33:50.960 --> 00:33:59.320 sure that they provide the an outstanding care and and quality and not just not just care but 00:33:59.320 --> 00:34:03.820 making sure that it's care that makes a difference you know that it's not just 00:34:03.820 --> 00:34:09.940 boy we want to become a robotic program but we want to become a robotic program that's really 00:34:09.940 --> 00:34:16.140 making a difference in people's lives and and i think that that commitment just goes a long ways 00:34:16.140 --> 00:34:22.660 and so i'm very grateful to have found an environment where that's the case and and i'm 00:34:22.660 --> 00:34:29.780 grateful to self for for being so supportive well thank you todd i really appreciate that and um 00:34:29.780 --> 00:34:33.300 Um, and I mean it heartfelt, love you, man. 00:34:33.300 --> 00:34:34.680 And thanks for being here. 00:34:34.680 --> 00:34:39.280 And, um, you know, what you, what you bring to the community is, uh, it's a big deal and, 00:34:39.280 --> 00:34:41.220 and, uh, uh, definitely appreciate it. 00:34:41.220 --> 00:34:42.620 And, and your lovely family too. 00:34:42.620 --> 00:34:43.680 Glad to have you all here. 00:34:43.680 --> 00:34:45.200 All right. 00:34:45.200 --> 00:34:50.140 Well, um, I think we'll wrap it up and, uh, that's the end of today's, uh, medically speaking 00:34:50.140 --> 00:34:50.740 podcast. 00:34:50.740 --> 00:34:55.900 We appreciate you all joining us today, uh, for this great conversation with Dr. Todd 00:34:55.900 --> 00:34:58.200 Hanson, and we look forward to seeing you next time. 00:34:59.780 --> 00:35:02.780 ♪ ♪