Laparoscopic or robotic surgery, surgical margin status has been used as a surrogate pathological marker to compare cancer control between laparoscopic and open techniques. buy viagra Indeed, positive surgical margins are associated with significantly higher rates of biochemical progression, clinical progression and death. Particularly early in the learning curve, positive margin rates in several laparoscopic prostatectomy series are concerningly high. For example, atug et al. Reported a positive margin rate of 45. 4% in the first 33 of hundred consecutive robotic prostatectomies, including 10 of 26 patients (38. 4%) with pathologically organ-confined disease. generic brands of viagra online In the next 33 patients and the final 34 patients, the positive margin rates decreased to 21. 2% and 11. 7%, respectively. viagra online Nevertheless, as baumert pointed out in an editorial comment, “the positive margin rate of the first group of patients is difficult to accept in this day and age. All teams new to robotic or laparoscopic surgery should initiate their programs with mentors to avoid ‘sacrificing’ the first patients. ” the learning curve involved in laparoscopic prostatectomy is a well-described disadvantage of the technique. viagra soft tabs better According to one estimate, it takes at least 40 to 60 cases for an experienced open surgeon to become proficient. Proponents of robotic prostatectomy have shown that the robot may decrease the learning curve for inexperienced laparoscopic surgeons to become proficient with the technique. viagra for blood pressure patients Nevertheless, there is clearly an inherent compromise of the initial patients being treated with these techniques. Fortunately, the current endoscopic equipment is useful in the instruction of these techniques, such that even the second assistant has an excellent magnified view of the anatomy and technique. Unfortunately, for practicing urologists who are adept in open radical prostatectomy, participation in such hands-on training courses requires a sacrifice of time and finances. viagra online without prescription Moreover, formal training in such complicated urological procedures is not yet uniformly available in residency training programs. Long-term cancer-free survival results most importantly, the laparoscopic and robotic prostatectomy have no track record in terms of long-term cancer control. viagra yahoo virus The surgical specimen is generally removed from a port site within an entrapment sac and no port site recurrences have yet been described. buy viagra cheap Nevertheless, the positive margin rates are concerning, and if small.

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