Dr. Taylor’s Interests & Accomplishments
Procedures performed with the da Vinci Robot
The most frequent robotic surgery performed by Dr. Taylor is the da Vinci Robotic Radical Prostatectomy, as treatment for prostate cancer. Since he performed the first Robotic Assisted Laparoscopic Radical Prostatectomy at John Muir Concord Campus in 2002, Dr. Taylor has performed hundreds of these procedures. This is in addition to over 700 Open Radical Retropubic Prostatectomies.
The da Vinci Robotic Radical Prostatectomy has essentially replaced the open technique for 99% of his patients. The robotic surgery attempts to mimic the open procedure by utilizing a minimally invasive method. This results in a faster recuperation, shorter catheterization times, more rapid return of good bladder control, more rapid return of normal sexual function, and more rapid return to normal activities. Long term data on cancer control rates is lacking, as the technique is so new that we do not yet have ten or fifteen year cancer specific survival data, as we do for the Open Radical Prostatectomy.
However, most urologists who are performing the Robotic Radical Prostatectomy feel confident that the long-term data will eventually show no difference between to open and robotic techniques. Intermediate endpoints, such as PSA recurrence and “Positive Surgical Margins” show no difference between the two techniques.
Robotic Partial Nephrectomy for Kidney Cancer
Dr. Taylor received special training at Intuitive Surgical in Robotic Partial Nephrectomy as treatment for kidney cancer. Dr. Taylor has been performing da Vinci Robotic Partial Nephrectomy since 2008 with great success. In years past, the whole kidney was removed if you had kidney cancer. For the past 10 years, most kidney cancers are discovered when they are small, less than 5 cm. If the kidney cancer is discovered when it is still small, he can often remove just the cancer with a small margin of normal kidney tissue, and preserve the rest of the kidney.
A laparoscopic technique was developed to perform Partial Nephrectomy, but is very difficult, requires great skill and training, and is challenging to perform in 2 dimensions. The di Vinci Robot allows him to perform the operation in three dimensions, with di Vinci wrists for suturing, and has made the operation much safer to perform. Many of his patients go home the next day after this minimally invasive procedure. He is accepting patients from surrounding communities for this procedure.
Robotic Pyeloplasty for UPJ Obstruction
Ureteropelvic Junction Obstruction (UPJ Obstruction) signifies a blockage between the renal pelvis (urinary drainage system of the kidney) and the ureter (the tube connecting the renal pelvis to the bladder). The blockage is usually congenital (born with it), but is occasionally acquired. The blockage causes urine to back up inside the kidney, and back pressure damages the kidney. Symptoms of UPJ Obstruction are flank pain, infection, fever, and blood in the urine. Occasionally, an ultrasound exam or CT scan of the abdomen can reveal a “silent” UPJ obstruction, before symptoms develop.
In the past, the “gold standard” for surgical repair of UPJ Obstruction, called an Open Pyeloplasty, involved a large flank incision (and large scar), several days in the hospital, and a long recuperation. The Pyeloplasty involved exposing and removing the blockage, and performing a plastic repair or reconstruction, to allow urine to flow freely down to the bladder without any backpressure on the kidney. Although Open Pyeloplasty had an excellent success rate of 95- 98%, urologists have been striving to develop less invasive methods of repair.
The Endopyelotomy was developed, where a scope was passed through the urinary passages to the point of obstruction, where hot wires or lasers were used to incise the narrow spot. An internal splint, called a stent, was left in place for 6 weeks, allowing it to heal properly. This was indeed minimally invasive, but had a high failure rate (as high as 50% in some cases).
Endopyelotomy is now used only selectively in cases where it has the highest success rate. Another attempt at a minimally invasive method of UPJ repair was the Laparoscopic method. Regular Laparoscopy involves the placement of a specialized telescope through the belly button, and small instruments placed through small incisions are use to repair the blockage. Laparoscopic Pyeloplasty requires considerable skill and training, and is very difficult to perform in two dimensions.
Robotic Pyeloplasty utilizes the da Vinci Robot to perform the delicate laparoscopic operation. The da Vinci Robotic Pyeloplasty is similar to the regular laparoscopic Pyeloplasty in that the instruments are placed through small incisions, avoiding large, painful, unsightly scars. The 3-D telescope affords much better visualization than regular laparoscopic telescopes.
The da Vinci Robot’s wrists mimic human wrists, and allow the surgeon to perform delicate precise movements to accomplish the repair. Because of the magnification and precision of the procedure with the da Vinci Robot, success rates are at least as high if not higher than with an open operation. Dr. Taylor has been performing Robotic Pyeloplasty since 2002. It use has replaced most other methods due to its less invasive nature, minimal scaring, minimal pain, and high success rate.
Vasectomy Reversal (Microsurigical Vasovasostomy and Vasoepididimostomy)
Dr Stephen Taylor has been performing Microsurgical Vasovasostomy and Microsurgical Vasoepididimostomy since the early 1980’s. He is highly skilled in microsurgical techniques, as well as a skilled Robotic Surgeon. He is currently trying to develop Robotic Techniques for Vasectomy Reversal.
A microsurgical vasectomy reversal is performed as an outpatient in an outpatient Surgery Center. The procedure can take 3 to 5 hours depending on the complexity of the reversal. It is usually performed under general anesthesia, but in some cases it can be performed under local anesthesia. The risks are quite small, but include bleeding or infection in less than 1% of patients.
Dr. Taylor has performed more Vasectomy Reversals in the East Bay than any other urologist, and he has an excellent success rate. He is currently trying to develop Robotic Techniques for Vasectomy Reversal. If you are looking for a urologist who has the most experience in this highly specialized technique, please call for an appointment.
Evaluation and Treatment of Prostate Cancer
Dr. Taylor has been evaluating and treating patients with Prostate Cancer since the early 1980’s, and has over 2,000 prostate cancer patients under his care. He wrote one of the first research papers dealing with Potency after Radical Prostatectomy, and helped to stimulate the development of the Nerve Sparing Radical Prostatectomy. He was one of the first urologists in the bay area to perform Prostate Ultrasound; to guide very precise biopsies to establish the diagnosis of Prostate Cancer.
He was also one of the first urologists to employ local anesthesia during the Prostate Biopsy to make the procedure as painless as possible. As of 2009, he has personally performed over 5,000 Ultrasound Guided biopsies of the prostate. When a patient has been diagnosed with Prostate Cancer, and the Grade (Gleason Score) and Stage (“T “stage or extent of disease) have been determined, treatment options can then be discussed. Dr Taylor attends several meetings every year to stay abreast of the latest developments and maintain state of the art skills. The treatment options include:
- Active surveillance (also called watchful waiting or expectant management)
- Radical Prostatectomy
- Da Vinci Robotic Radical Prostatectomy
- Open Radical Retropubic Prostatectomy
- Radiation Therapy
- External Beam Radiation Therapy
- Interstitial Brachytherapy (“Seeds”)
- High Dose Rate Brachytherapy (HDR Brachytherapy)
- Cryotherapy (Freezing)
- “Hormone Therapy” (Androgen Ablation Therapy)
- Other unconventional therapies
Dr. Taylor is often asked to see patients for “second opinions” as an unbiased expert in the field. He will review all the treatment options; discuss their advantages, disadvantages, risks, and reasonable expectations. Also, various “cure” rates, side affects, and quality of life issues will be discussed, so patients can decide for themselves which treatment is best for them.
Dr. Taylor has personally performed over 700 Open Radical Retropubic Prostatectomy operations. Since 2002, when the da Vinci Robot arrived at John Muir Concord Campus, he has devoted himself to mastering the Robotic Radical Prostatectomy. He has attended many meetings where the latest techniques are discussed, including the World Robotic Symposium in 2008 and 2009. He has personally performed hundreds of Robotic Prostatectomy operations and he is very gratified with the results, compared to the open operation: shorter hospitalization, less pain, less scaring, quicker return to normal activities, faster return of good bladder control, and quicker return of sexual function.
Infertility: Evaluation and Treatment
Dr. Taylor has been interested in the evaluation and treatment of infertility for many years. He has attended many continuing educational symposium, including the “Advances in the Evaluation and Management of Infertility” postgraduate course presented at the American Urologic Association meeting in May 2008. He is an expert in Microsurgical Vasectomy Reversals and has performed hundreds over the past 20 years. He has more experience in Microsurgical Vasectomy Reversal than any other urologist in the East Bay. (See section on Infertility.)
Impotence and Erectile Dysfunction
Dr. Taylor is a member if the Impotence Institute of America. He is an expert in the evaluation and treatment of impotence and erectile dysfunction. Many men over the age of forty and fifty experience erectile dysfunction. Although originally impotence was perceived to be psychologically based, we now know the vast majority of cases have physical causes. When seen in the office, an appropriate evaluation is performed to determine the root cause of the problem.
The evaluation may include a physical exam, blood tests to measure various hormones, and possibly a Penile Doppler Blood Flow study. Based on the test results, specific recommendations can then be made to address the specific cause. In addition to medications, other treatment options include:
- Hormone Replacement Therapy (rarely used)
- Vacuum Constriction Devices
- Intracavernosal Injection Therapy (injection for erection)
- MUSE (urethral suppository for erection)
- Penile Implants (Inflatable Penile Implants)
All the treatment options available will be discussed, so you can decide which treatment option is best for you.