Page last updated at 23:33 GMT, Friday, 15 May 2009 00:33 UK

'I had pain-free prostate recovery'

By Jane Elliott
Health reporter, BBC News

Michael Sinclair
Michael was delighted to be out of hospital in a day

Michael Sinclair is a man who hates hospitals.

So when doctors told him he could become the first man in the UK to have his prostate gland removed as a day-case after being diagnosed with cancer, he leapt at the chance.

Within 12 hours of the operation he was at home and the next day was taking gentle exercise.

"I fronted up at the hospital at 7am, they took me for the op about 8.30am and I came round about lunchtime and I was home by 8pm," he said.

Speedy recovery

"The day after the operation I was going for short walks and by the end of the week long walks of up to a mile. Now I am totally active and back to normal.

"The only thing I haven't done is ride my bike, because it is putting pressure on where the prostate was."

I still can't believe I experienced absolutely no pain in the hours and days after surgery - it's incredible
Michael Sinclair

His consultant urologist, Mr Mathias Winkler, said the whole day-case procedure had been made possible by nerve blocker drugs, which were used for the first time for this sort of operation by the Imperial Healthcare team.

Ultrasound technology is used to insert the nerve blocker drugs into a part of the abdominal wall, to stop the surrounding nerves transmitting pain signals back to the brain for up to 18 hours.

This means the patient, who is sedated for surgery, does not then need additional morphine and can be sent home with just simple painkillers and anti-inflammatory medicine.

"This is the first time this has been accomplished," said Mr Winkler.

Day-case benefits

He said getting the patient home the same day has lots of benefits - open surgery to remove the prostate takes between five to seven days and keyhole surgery two to three days.

"It is conceivable, although not proven, that if you go home earlier without sleeping at the hospital then your risk of acquiring hospital acquired infections such as MRSA is reduced.

"Also the recovery rate should be better - if you sleep at home you have a better sleep and get back to a normal life quicker.

The prostate gland is located below the bladder and in front of the rectum
It is about the size of a walnut, producing the liquid that nourishes, protects and carries sperm on ejaculation. It tends to increase in size with age
Prostate cancer is the most common male cancer in the UK, accounting for almost a quarter of male cancers
Each year, almost 35,000 men are diagnosed and more than 10,000 die from the disease

"The patient has a fairly major operation, but can then get back to a fairly normal life and into a routine."

He added that the operation, a laparoscopic (keyhole) radical prostatectomy, had also been fine-tuned by using the same teams of staff and encouraging familiarity.

"You have to use the same team to get the results and reduce complications," he said.

"If you train your team well you can achieve a better outcome.

"People pull together and focus on a common goal, and that should be solely the patient's outcome."

Still pain free

Mr Sinclair, aged 67, from Twickenham in south-west London, said he had been delighted by the results of last month's surgery.

"I still can't believe I experienced absolutely no pain in the hours and days after surgery - it's incredible," he said.

A prostate cancer cell. Pic caption: Nina Lampen/SPL
Prostate cancer is the most common male cancer

Later this month he will have blood tests to see how effective the surgery has been.

Dr Ian Smith, consultant anaesthetist and president-elect of British Association of Day Surgery, said it was a remarkable achievement.

"Only a few years ago prostate removal following cancer was a major open operation that required a lengthy hospital stay, and it is a mark of how quickly surgery and anaesthesia has developed in recent years that it is now feasible to do as a day case," he said.

"In order to successfully get someone home the same day there needs to meticulous preparation, a highly motivated patient and lots of reassurance from clinical staff, but the benefits of improved recovery make this worthwhile."

John Neate, chief executive at The Prostate Cancer Charity, said that any improvements were to be welcomed, but cautioned that properly evaluated trials were still needed.

"If the new technique works well, as this case suggests, and any side effects are minor, it could be adopted by surgeons who also do minimally invasive keyhole surgery for prostate cancer elsewhere in the UK, spreading the benefits to other men."

But he added: "The development of new surgical techniques is much less rigorously controlled than the required processes for new drug development.

"It will therefore be important to ensure that any extension of this particular approach to prostate surgery and pain control is properly evaluated with a larger number of patients."

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