𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜

Drowning in bureaucracy & EHR hell? Step into the OR. Subtle and still surprising varations in renal hilar anatomy. The ureter peristalsing like clockwork. The course of the obturator nerve... Unchanged since the dawn of surgery. Untouched by spreadsheets. Untouched by admin. It's breathtaking. Lucky us.

@DrSpratticus @dr_coops @Uroweb @BogdanaSchmidt @ChapinMD @wandering_gu @qdtrinh @jeshoag @SFreedlandMD @EUplatinum @UrologyUS And before someone says "we thought that was true of the transition from Open to Robotic..." Totally different. Here we have improved magnification, pneumoperitoneum, etc etc. These features are shared by multiport and single port.

I can tell you my take based on my experience as a multi-port surgeon, which apparently differs from all the other comments here. I also helped to work on some of the earliest laparoscopic single-port surgeries in the early 2000s. Better outcomes in prostate removal come from experience and preservation of as much surrounding anatomy as possible. From my point of view, that comes from making good DECISIONS with your surgical plane choices, and anatomical preservation. I can't for the life of me logically understand why it would be in any way based on single port versus multi-port. A single port surgeon can make poor decisions, as can a multi-port surgeon, and vice versa.

Urology community Help teach us non-surgeons the benefit of single port and continence outcomes. Is this something that improves outcomes? @dr_coops @Uroweb @BogdanaSchmidt @ChapinMD @wandering_gu @qdtrinh @jeshoag @SFreedlandMD @EUplatinum @UrologyUS

@Shpigford My instance of CoWork only had projects for chats, not for cowork. So in that sense, it’s new.

not clear to me how this is different than just working in a folder (which Cowork already had). 🤔

@RamPathakMD @Justindavidmed @drjkaouk 🤔

@CanesDavid @Justindavidmed @drjkaouk Number of skin incisions isn’t the factor. The ability to dock the robot transvesically, avoiding adhesions (j-pouch video shown). Also, less traction force on surrounding structures is easier done on this platform. Quicker return to activities (no lifting restrictions, etc.)

Excellent talk by @drjkaouk on Single Port prostatectomy. Data shows early return to continence compared to multiport, consistent with what we’ve seen with our transvesical single port prostatectomies @RamPathakMD

If patients can’t complete the intervention it would stand to reason that the intervention does not work…

@RamPathakMD @Justindavidmed @drjkaouk Aren’t those all surgical decisions rather than number of skin incisions and tooling considerations?

@CanesDavid @Justindavidmed @drjkaouk 1. Ultra preservation of anterior structures 2. It is Retzius sparing 3. Not hypermobilizing urethra 4. taking the prostate out of its “cocoon” and not harming surrounding structures.

@HealthcareAIGuy This was also done around 20 years ago

A surgeon just removed a man’s prostate… from 1,500 miles away. In London, Dr. Prokar Dasgupta controlled a 4-armed robot operating in Spain with just 0.06s lag. Do you think remote surgery, whether by a surgeon or AI, will be the future?

@DonaldVinh That’s not really the conclusion.

Turns out that the human body is more complex than a tube

@DrSpratticus @dr_coops @Uroweb @BogdanaSchmidt @ChapinMD @wandering_gu @qdtrinh @jeshoag @SFreedlandMD @EUplatinum @UrologyUS 🍿 😶

@doctormacias @EIvanBravoC Wrong conclusion. That’s not what it shows

Si has tenido un cálculo renal, se te ha advertido que lo más importante para prevenir otro ataque es aumentar la hidratación. Un ensayo aleatorio de hidratación en más de 1600 participantes no mostró ningún beneficio, a pesar de la evidencia de aumento del volumen urinario.

Exactly

@dereckwpaul 💯

Some experts do not think OpenClaw is relevant to AI in healthcare. They are wrong. OpenClaw represents us phase shifting in the way we relate to AI systems again. We are moving past promting a chatbot to ask a question so that we can do the work. We are moving past prompting an AI agent to go off and do a defined task itself. We are arriving at providing an AI agent with an objective and it continuously prompting itself to go off gather information and take actions that advance its objective. In medicine, this will look like an agent scouring a panel of active pateints for care gaps, lab trends, or treatment optimizations. Continuous clinical inference — always on is future of all AI knowledge work, medicine included.

@urogabe @DrSpratticus @TheLancet Sort of. It really means that if you tell people to push fluids, and they don’t drink the recommended amount, nothing changes. Says nothing about proper fluid intake and stones.

Important new study in @TheLancet - a behavioral intervention to promote high fluid intake among kidney stone formers did not significantly impact recurrent stone events on 2y f/u Flips secondary stone prevention dogma on its head - kudos to the PUSH trial authors

@EricTopol Total fail, Eric. The increase in volume was negligible between control and intercen, and the intervention group was 40% below the recommended guideline. This trial only showed that compliance is difficult.

@LaheyUro journal club

@anandbadrimd It’s 95% related to WellPrept Client proposals Website revamps Feature prototypes Strategic planning Sales/Demo decks Content curation Case studies For Urology, creating talks. Practice website creation and updates…. Highly swayed towards entrepreneurial pursuits

@CanesDavid What do you use it for in your day to day?

If there’s one lesson that Claude Cowork reinforces it’s this: context is everything. With a 1M token context window, I can feed it like a ravenous animal, and the quality of the output absolutely soars. I imagine all founder/CEO’s are in absolute heaven at the productivity this unlocks. What a time to be alive. I’m continuing to do my best to dismantle the messy parts of being a doctor. This way only the joy remains.

I also tend to NS in high risk if dominant lesions not near NVB on MRI I highly value your opinions Brian nearly without fail. This one shocked me tbh. This has “near-retirement open surgeon still justifying Open Prostatectomy” vibes. 😂🤣 I kid, but… hey. That’s what it reminds me of. I wonder how often your DRE is discordant with what you already planned/saw based on MRI?

@DrSpratticus @dr_coops @urotoday @UroOnc @Uroweb @wandering_gu @BogdanaSchmidt @CanesDavid @DrMLChua @HimanshuNagarMD @AmarUKishan @piet_ost @alison_tree @declangmurphy @uroegg Limited data zone, I find it helps me w/nerve sparing decision/plan. Equivocal MRIs + Rads comments on EPE/abutment doesn’t provide the risk assessment of a full Nspare like palpating the surface + tumor. I tend to Nspare even in higher risk tumors when a high priority for Pts

#EAU26 DRE not recommended for asymptomatic men. What are people’s thoughts on need for routine DRE in era of MRI? @ChapinMD @urotoday @UroOnc @Uroweb @wandering_gu @BogdanaSchmidt @CanesDavid @DrMLChua @HimanshuNagarMD @AmarUKishan @piet_ost @alison_tree @declangmurphy

Something I’ve never shared publicly before. Early in residency, I placed a “simple" suprapubic tube. It went fine. Then my patient died. I nearly walked away from surgery forever. Turns out residency never ends. The doubt, the what-ifs, the crushing weight of decisions… they follow you your whole career. Here’s how I’ve learned to carry it anyway: leezhaomd.org/post/the-endle… @AmerUrological #MedTwitter #Surgery