Sarah Goodwin

Kathi Ovnic
Holly Korschun
March 11, 1999


An Emory University surgeon has developed a less invasive surgery for prostate cancer than the traditional radical prostatectomy. Fray F. Marshall, M.D., chair of the Department of Urology at Emory, originated the minilaparotomy radical retropubic prostatectomy for patients with advanced prostate cancer and is one of the few people in this country trained to perform the procedure.

More than 80,000 patients each year have a radical prostatectomy, in which the prostate and surrounding tissue are removed to prevent spread of prostate cancer. The traditional surgical procedure is a radical prostatectomy, in which the surgeon makes an incision from the penis to the navel. In a paper published in the December 1998 issue of The Journal of Urology, Marshall compared the benefits and outcomes of traditional radical prostatectomy with the new surgery, which is performed using specially designed equipment and a robotic assistant.

The minilaparoscopic approach requires a smaller incision - about 30 to 40 percent smaller - than the traditional surgery. The new approach also utilizes one human surgical assistant and one robotic assistant, cutting down on the number of human assistants needed to perform the surgery.

"The robot basically holds open the incision so the surgeon can perform the procedure," Marshall says. "Since the surgery can take several hours, and with the minilaparotomy you have a smaller incision and you are using smaller instruments, it's important for that incision to stay firmly open for the amount of time needed to perform the surgery. With the robot you have no concerns about your assistant tiring or not having the strength to hold the incision open for such a long time."

Marshall not only developed the minilaparotomy prostatectomy but designed some of the surgical tools used in the procedure.

In his comparison study, Marshall surveyed 522 patients on whom he had performed minilaparotomy prostatectomies over a six year period. With a survey response rate of approximately 50 percent, Marshall and his team received information on the patients' post-surgical complications, continence, potency and post-operative PSA counts. The results showed the outcomes for the two procedures were very similar. The potential benefits of the newer technique were less pain and recovery time for the patient because of the smaller incision, and, with the use of a "robotic" second assistant, a more efficient and effective surgery.

Marshall was recently named as the first chair of the newly created Department of Urology in the Emory University School of Medicine. Marshall comes to Emory from Johns Hopkins, where he has been one of the nation's top urologic surgeons and clinical researchers in urologic cancers for nearly 25 years.

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