Chapters Transcript Video What I’ve Learned From Performing 7,000 Robotic Prostatectomies As we've learned more about prostate cancer over the years, uh, there's lots of good studies which demonstrate that men who have high risk disease, which used to be the better radiation candidates, they're actually better served by surgery first and then adding radiation afterwards if they need to. Hi, I'm Lindsay Carrillo, director of business development at UCI Health. Hi, I'm Doctor Sunil Verma, Associate Chief Medical Officer for ambulatory care here at UCI Health. I'm also a laryngologist here. Welcome to Physician Huddle by UCI Health. Today I'm really excited that we're joined by Doctor David Lee, professor of urology and director of the Comprehensive prostate cancer program at UCI Health. David, um, I've had a chance to meet you in the operating room a few times, but I'm really excited to sit down with you and actually talk shop. Welcome. Thank you. No, it's a pleasure to be here, really excited to be doing this. So, you know, tell us a little bit about, you know, about your role here at UCI Health. When did you join us? Yeah, so it's been about 4 years now that I've been here. I was at the University of Pennsylvania for 16 years before I came, um, but I did 1 year of my fellowship training here at UCI. So in some ways it's like coming back home. Um, I was a fellow under Dr. Ralph Klayman, who was our dean for a while, helped build that new hospital, um. On our orange campus, which has been become very well used and so crowded these days. Um, but, uh, during that time when I went away, I came back, um, I was his fellow, and one thing he always says to me is, you know, David once a fellow, always a fellow, yeah, so it's definitely nice in some ways being home is kind of like family. So I remember looking at your recruitment, they were telling me that you were coming, and so I started Google stalking you and realized like, oh, this guy, he's doing NBA players, he's doing the top notch people, and I understand you just hit a fairly sizable milestone of 7000 robotic prostatectomies, which is huge, and I think Possibly the highest in the country. You have to fact check me on that, but tell us a little bit about that journey between case one and case 7000. What are the changes that you've seen? What are the changes you've implemented? Oh yeah, there, there's a lot of changes. So um yeah, so one thing I always say about having done so many cases now is that I've just spent way too much time in the operating room. Uh, but that investment of time has really, I think, uh, gone on to provide patients with better outcomes, which I think we're all here trying to do our best so that guys go through this very scary experience of the diagnosis of prostate cancer and then. Facing these different treatment options, which then could affect their quality of life and then really their mortality, which for a lot of guys, it's a really huge deal because it's the first time through their adult life, they've gone to the point where they have a medical problem which could actually kill them. And then so it's a very scary experience, but then uh telling patients, yeah, I've actually done over 7000 of these, it gives them a lot of comfort knowing that. Um, yeah, I think I'm the 2nd highest volume surgeon in the country, um, having done that many. And so patients understand that experience really plays a big role in providing them with really good outcomes with cancer cure and quality of life issues. Um, and then so they feel a lot better going through that whole process and you know, one thing that I've always tried to instill in our team, uh, taking care of the guys is that it is a scary process. And by demonstrating that we really care about them and that we know that what we're doing, having taken care of so many guys, knowing what kind of problems they could expect going through the surgery and the recovery, it really helps the guys to kind of emotionally. psychologically go through that really difficult process. Um, but yeah, no, the, the whole kind of face of prostate cancer over that period of time has changed, uh, because I first started doing this, as I mentioned when I was a fellow here at UCI. So I was really lucky enough to work with uh Dr. Klayman and Tom Ollering, Tom, who's uh still on our faculty. Um, he, he and I, when I was his fellow, we did the 1st 50 robot prostatectomy cases in Southern California. Uh, so that was back in 2002 to 2003. And so we were one of the very first, um, experiences besides the pioneering experience at Henry Ford Hospital, um, where Dr. Mennon and his team did the first big series of robot prostatectomies. And then so our um Uh, experience became kind of that second validation uh for surgeons to say, oh yeah, this is really something. Um, but then when I went to the interview for jobs afterwards, after the fellowship, I really believed in robot pro protect me and thought it was, it was going to be a really big thing. But then I went to interview at several different academic places. And the response I got from most of the places was, well, we have open surgeons who do open radical pro technis. I don't think we really want somebody who's going to do robot pros techs. No way. They weren't even interested. They weren't even interested. Yeah, so we were that early on in the curve. And then so I was fortunate where I got a great job with uh actually a private practice in Dallas Fort Worth, um called um Urology Associates of North Texas, and there were 50 urologists all in the same group. And then so there are these really big mega groups in private practice all across the United States, so I joined one of them, but it was because they had a really, you know, strong belief that this was gonna be big. And then so with their support, I went on to do 450 cases in 2 years there, and then, then I went to Penn where I developed kind of the biggest experience in the Northeast US in a relatively short amount of time. Uh, working at Penn and so by the time that I transitioned over here, I was doing 20% of all prostate cancer surgery in eastern Pennsylvania, all the many urologists working there. Um, and then so, um, yes, so then Dr. Landman recruited me to come back, um, and work at the new cancer center in Irvine, um, which we opened this year. Uh, which is a fantastic place to work. It really suits my practice really well because we send um 95% of the guys home the same day after robot prostatectomy, which very few places in the country do, um, but it's, it's this beautiful synergy between um the hospital, the beautiful environment, the great technology that we have there. Um, and the support of the leadership, um, which I think is doing wonderful things here at UCI right now. So there's is, is robot prostate surgery for, is that the standard of care should all prostate cancer should be treated that way? Uh, I know there's radiation options, um. And then you also hear you, you talk, I mean there's sort of that dichotomy that for a lot of people prostate cancer is very livable, but then also you just mentioned facing your own mortality. So maybe talk to us a little bit about why, what, what is is is robot prostate surgery just about the tool or is there something different about it? Yeah, no that that's a great question and it hits on a lot of really important points about prostate cancer. Um, so there is this kind of old wives' tale about prostate cancer and it's very slow growing and a lot of men die with it, but don't die of it. But actually, uh, there's been some really good outcome studies now looking at the Medicare population and in fact, the older that men are when they're diagnosed with prostate cancer, the higher the likelihood is that they actually have high risk prostate cancer. So then the idea of just kind of not caring about it after a certain point in time, um, especially if you're just going by calendar age, I don't think serves people really well. I think you have to go more by what their longevity realistically looks like. So, um, I do think that there's a point where PSA screening doesn't have to go on and on for a lot of men, uh, but I think it's more looking at If they're gonna be around 10 years or more, then it's still worthwhile screening because prostate cancer is kind of a horrible way to die. And so if we can prevent that, then I think it serves men really well. Um, But then for a long time with prostate cancer, um, Our ideal prostate cancer surgery patient used to look like younger men with really good kind of quality of life factors already like they were super healthy, um, were fit and had good erection function, then we could do a nerve saving operation for them and we do that open, you know, back in the day when I was a resident, we do the mostly the of most of them open. Um, but then the technology with the robot, I feel like has really demonstrated that we do a better operation with the robot than open. Um, and what is it about the robot? Like what makes someone who doesn't do robot surgery, what makes the robot a better tool? Yeah, so we can uh then do the operation which used to be done with a 6 or 7 inch lower abdominal incision with a big retractor, uh. And we turned it into a laparoscopic procedure. So then, uh, filling the belly up with the carbon dioxide gas to hold our pneumo peritoneum pressure, um, that actually push pushes shut a lot of the big veins inside the pelvis and then so our blood loss ends up being minimal, whereas open when you cut into any of those little veins, they bleed like crazy, so I'm sure in, in your field that happens. Yeah, the venous bleeding is significant. Um, in open surgery in the pelvis, it's very significant with laparoscopic approaches, it makes it like practically nothing. And so blood loss, um, I transfuse less than 0.5% of the guys that I do the operation for robotically, but if I was still doing open, I would probably still have my patients donate auto donate some blood beforehand just as a matter of routine, exactly because I think even really good. The open surgeons will transfuse 30 to 40% of their patients. Yeah, so, um, because the incisions are smaller, uh, the guys get back to work more quickly. Uh, so I tell the guys after I do a robot prostatecting for them, they could go back to the office all day. In 2 weeks afterwards and then um full activity in like 3 weeks, so golf 10, swim lift, run by kite, whatever they want to do after an open radical prostatectomy, that wouldn't happen for like 2 to 3 months because of that lower abdominal incision and you know, cancer cure outcomes are just as good with robot versus open. And then, um, I think there's the centers that do high volume, uh, I think we've definitely demonstrated that uh you're in control and sexual function outcomes, which are, you know, the big quality of life things for the guys, uh, they're better with the robot. And I think it's because even though it's a laparoscopic procedure, uh, once, We have our robot set up, um, the long working instruments have wrists at the tip, and then so that wrists, those wrists help us to very precisely do our nerve saving operation, uh, to save all of the muscle floor, blood vessels and so all of that leads to quicker recovery, um, especially of those um quality of life factors. So, and then, um. Yeah, the, the robot is one thing, uh, that's an option for a certain type of patient, which used to be these younger guys. uh, but then as we've learned more about prostate cancer over the years, uh, there's lots of good studies which demonstrate that men who have high risk disease, which used to be the better radiation candidates, they're actually better served by surgery first and then adding radiation afterwards if they need to. Uh, but a lot of these higher risk guys, even if they are, they're older, we can give them a really good cancer outcome, uh, with still really good quality of life outcomes. Um, because it used to be with an open operation, you wouldn't want to do that for somebody who's 75 because it's a tough operation to get through. Now with the robot, because the guys recover so much more quickly, it's something that's very doable, you know, I tell most of the guys, the recovery isn't that different than a hernia repair. And then so from that point of view, we can even offer it to older men, um, and that allows them to get the benefits of surgery, uh, not have to undergo the side effects that radiation may cause, uh, and then, Um, provide them with a really great option. Um, but radiation is still an excellent option for a lot of men. Uh, their radiation comes in several different forms like brachytherapy, which are seed placement, external beam, proton therapy. Uh, but all of those options, um, place radiation in the prostate, the prostate is still left behind, and cancer can recur from inside the prostate. So I think if anybody's got a more than 10 year life expectancy, surgery is probably the better way to show, yeah. And then uh one outcome that's come from a controversy that came up about PSA screening. Um, is that we, the thought came up, the discussion came up that maybe we overtreat a lot of guys because yeah, when we diagnose some guys with a slower growing prostate cancer. Um, especially if they're older, they may never be bothered by their prostate cancer. So we do a lot more active surveillance these days as well. And how is that physical exam, is that imaging labs, all of the above? Great question. So, um, the process is usually to do the PSA blood test, which is the screening test for prostate cancer. We do that on a much more regular basis, so I usually recommend the guys on surveillance. Uh, do a PSA every 3 to 4 months and then we'll do an MRI and a biopsy for them like once a year or if the cancer doesn't look like it's progressing, then we'll stretch out the interval between that's at least where you start off protocol, right. Yeah, so we offer a lot more surveillance these days, which I think is also a really big benefit for a lot of the guys, especially if they're older. Um, because it's not as threatening for a lot of those guys, um, but then there is the kind of mental cost regarding surveillance because it can be difficult for some guys to just kind of sit with that and live with that. uh, the cancer diagnosis freaks a lot of people out, understandably, um, but yeah, we do try to do a good job counseling these guys that, yeah, you know, you're This may not affect you for a really long time and then there's a lot of big uh surveillance cohorts out there which demonstrate that uh at least 50% of the guys can go 10 years doing surveillance if they're properly selected at the outset. It certainly sounds like, you know, you have a program, you know, you've we've developed a program. This isn't just talking about surgery for all and or this is just a great tool. It's a real program to treat these men for a disease that Um, like you said, they don't really aren't coming in prepared. What was it like coming from the East Coast? What lessons did you learn out here and how have you set up the program here differently? For a lot of people, a lot of us physicians, the thought of transplanting ourselves to another place is, is very intimidating. How did you use this to your advantage to help the, to help the practice and frankly, the patients of Orange County? Yeah, no, that's a great question, and I think that's kind of evolved with these different changes in prostate cancer. Uh, one of the things that I think we've realized really well is that especially when guys have high risk prostate cancer, it does take a team. So that multidisciplinary approach, uh, where you have to bring in the radiation oncologist, the medical oncologists to all work together, um, is really important and optimizes outcomes for a lot of men with the high risk prostate cancer. And so this is one beautiful thing about the Irvine set up now with our new cancer center there. Um, we have radiation oncology there. Um, I, uh, run a multidisciplinary prostate cancer clinic, so I work right next door to our medical oncologist. So then if we have a question about, you know, what's going on with the patient or maybe oh can you just Come and see this guy real quick. Yeah, it's, it's really convenient. It's really nice that patients can come to one's place and then get all of their different options. Um, yeah, so that's been another big change with prostate cancer, the urologist used to do the biopsy, then we do surgery for the guys, and then if they needed radiation, then we'd refer them to radiation, but then see them back and then Uh, the hormone therapy was the only kind of um systemic therapy that we could offer for men with prostate cancer, and so the way that that works is it just shuts off the testosterone production in somebody's body and that makes the prostate cancer actually regress, but it's only got a limited effectiveness as far as duration goes. And then so, um, but the urologists used to handle a really big percentage of that uh in a prostate cancer patients care. Um, now, uh, radiation has become more varied and a lot easier for a lot of the guys and can be more exact with um fiducial placement, um, and then the whole field of systemic therapy has changed dramatically. There's 5 different, um, very effective medications now for prostate cancer, more coming down the pipeline. Uh, and so we really need our medical oncologists because uh there's different protocols of adding these medications together at different time points, which optimizes outcomes and so. Many guys, even with intermediate or high risk prostate cancer in the long run will live a long time with the help of these medications. So failing surgery and radiation don't necessarily mean that the guys will pass away from the prostate cancer anytime soon. So yeah, so it's changed a lot. Incredible. And I know you keep a lot of your own data. I think you implement a lot of just process improvements or things where you want to just even improve. Your own numbers, but that probably a lot of extra work. I'm guessing a lot of docs don't spend time doing that. Like, tell us where that comes from and how does it inform your practice. Oh yeah, no, I think you don't, so I'm I'm a golfer, so I enjoy that. Yeah, yeah, right. It's hard. This obsessive compulsive thing, but you end up with your score afterwards, right? So then you know, kind of based on your score and how you've hit the ball that day, like what kind of player you are. If you don't look at your surgical outcomes afterwards, I don't think you know what kind of surgeon that you are. And so one thing that I've done from the very beginning is I've kept data sheets on every single guy that I've done surgery for, and then so that's how I know how many cases I've done, but we keep a database of all the guys, um, you know, including their, what their cancer looks like, what their quality of life of outcomes look like. And so it's, it's a great place to start off, but then it allows us to try different things, try different techniques in order to help us to provide patients with better outcomes. And so this is kind of manifested in a couple of different ways. So, um, I changed my nerve saving approach, so the nerves that we, I refer to are the sexual function nerves, so it helps the guys to regain their erection function afterwards. Um, but then we altered our approach in order to help guys actually hopefully get their urine control back a little bit quicker, uh, but then after this change, tracking our outcomes, we actually saw that, yeah, their urine control outcomes were better, but their sexual function outcomes were also better, which was a little bit unexpected. And so this, this helps to give us confidence that we're doing the right thing. You're tracking data not just clearly at the time of surgery or pre-op. I mean, you're, you're tracking these individuals a lot longer longer, yeah, so we send quality of life questionnaires to all our guys afterwards. I see a lot of my patients back afterwards, um, and so this really helps to keep us on track as far as how the guys are doing. Um, another place where I think it's really helped is, um, the robotic technology keeps evolving and so now we at UCI have a single port robot where, you know, uh, Our ENT colleagues are using single port uh in order to do head and neck cancers and so urology is also applying this to prostates and kidneys and so, um, you know, but the, the environment, the working environment is actually a little bit different, the instruments don't work exactly the same way, so it is very challenging, especially for somebody like me who's done so many multi-port robots to then switch to that single port. Um, you know, it's, it's a little uncomfortable, and then so at the beginning, I questioned a little bit. Am I providing as good an outcome by switching to this modality, which feels more uncomfortable to me, more frustrating to me. Um, but then now we have our longer term outcomes after looking at our single port learning curve and our outcomes are actually exactly the same, if not, maybe even a little bit better, we probably don't have enough patience to judge whether it's better, but I'm not doing a worse job. And so um that. These kinds of outcomes, if you track them, you can really tell how you're doing and you know how you're taking care of the guy. It's it's, it's uh sort of ages you when you realize there's a new tech you know. At one point you're the one developing the technology and then you make the comment, gosh, this new one, do I really need to adapt to that, right? So you look for technology's sake, right? Like, of course, someone always wants to come and sell you the next, you know, fastest, better, you know, whatever widget, and it's only going to cost you $10 million. So just, you know, bring it on and I feel like you, you're sitting in a place where you've got a pretty good perspective. Yeah, I know, and, and it's, it's very interesting. There's other robot companies out there starting to compete with the main robot supplier that we use, um, but yeah, how is that going to add value? how is that going to help our patients? How is that going to help me to do a better job for our patients? I think we always have to question those things as these new technologies come about. Um, but yeah, you know, the single port robot, I do think actually has a certain role. um, and so one of the approaches that we're starting to do a few of my other faculty members, um, are also doing this, we can actually put that single port directly into the bladder to start off with and then that way we avoid going to the abdominal cavity. Altogether and then for men with really enlarged prostates, then we can do a robotic surgery to just core out the inner part of the prostate to help them with their urinary function. Oh, so now we're thinking outside of, outside of cancer too, yeah. And then so for kidney tumors, um you can also use a single port robot, especially if it's a lower pole tumor and then you can get very close with that single port immediately and then not have. To do that whole other dissection which is required when we're going through the abdominal cavity. So yeah, so yeah, so, so it, it's interesting, um, yeah, it does make us a little uncomfortable and we feel like, oh, we got to stay, stay up to date, uh, but yeah, we can also then help to define for other surgeons like where the value really is, so yeah. So you were, you mentioned outpatient surgeries and with 95% of the men going home, you know, same day, next day, you were telling me that the COVID pandemic actually played a role in this, uh, at UCI. Tell us about that. Yeah, it was very interesting. So, um, you know, COVID was difficult for surgeons because we couldn't go to the operating room, you know, we were worried that The ICUs would get full, which they were, you know, our emergency rooms would get full. Patients didn't want to come to the hospital if they didn't have COVID. Uh, so everything shut down for a couple of months, um, but as things look like they were getting under better control, like how do we turn, turn the spigot back on, cause the hospital needs some revenue and, you know, keep, keep things going and then I had a lot of patients with prostate cancer who needed surgery, so Um, but one of the things pre-COVID that we had worked out was a way, a pathway to allow patients to go home the same day, because for years I was taking care of these guys, I'd see them in the hospital the next morning, and they look completely fine. They're like, I asked them, how are you feeling? And they go, oh, the breakfast was terrible, hospital food is terrible, you know, and so I mean they feel fine. They rather maybe be home. Exactly, yeah. So then we started thinking, oh, you know, how can we get the guys home? So I worked with our anesthesia team, uh, pre-COVID to work out pathways to help their pain control, help them to feel better immediately in the recovery room. And then so uh after we developed the pathway, we started offering it, but only about 5 to 10% of guys were like, OK, I'll try to go home the same day because the standard was to stay overnight. So, but then when COVID happened, and then we started trying to turn things back on, and there and there were no hospital beds, people started making different decisions, right? It's like, oh, you have this, I can wait months till you have a hospital bed or I can just get this done now. I get home the same day. So immediately when we restarted. Uh, offering robot prostatectomy for patients again, go, you can go home the same day. So then right away, 70% of the guys started going home the same day, and then we keep, you know, that other 30% in recovery overnight. Um, but then when I transitioned to UCI, um, which was actually during COVID, uh, I just started telling all the guys, you're going to go home the same day because I had developed a lot of confidence in this pathway now, and I think also there was a reflection on the part of patients that being in the hospital, we know as physicians, being in the hospital isn't always the best thing for, for a number of the factors we know. But that really opened eyes up to a lot of patients that, hey, being in the being outside the hospital is probably safer at certain times, especially in during a pandemic so I think it opened patients' minds up very differently um and so probably facilitated the changes that you were, you know, you and your colleagues have been envisioning. To actually just turn into action. So a lot of different factors in the hospital, right? It's a, there's a lot of instructure, but you're saying that a lot of other physicians, other urologists haven't really made this leap yet, you know, no one's really pushing for them to do outpatient. So this is pretty unique. Yeah, I think it's, they just haven't done enough of it. Where they feel confident, but yeah, again looking at outcomes, um, we actually did a comparison study between our guys who would stay overnight and guys who would go home the same day, um, and there's no difference in the number of times they go to the emergency room or even call the office afterwards. And so yeah, it gives us a lot of confidence that way, um, but yeah, it. I do actually think that the pathway is important, but the most important seed that you can plant, which, you know, it all kind of works together from what we were talking about, is just you tell patients you can go home the same day and it's really safe just from the outset. And then when you plant the seed that way, they're like, OK, yeah, and then, you know, with all this background where you, you don't want to stay in the hospital and get COVID or any kind of other infection, it really, really helps to set the stage. Yeah. Convincing. Yeah, sure. So you're no stranger to innovation. We've come a long way from the days that you're having to go around and peddle robotic surgery is like this brand new phenomenon. Um, what do you think is coming next in the future? Yeah, so actually the technology in robotics keeps improving. Um, the latest generation of the robot actually records a lot more data as we're doing the operation and so You can actually do instant replay on your cases. So the, the company uh records data about who's working at the console, which instruments are being used, how you're moving your camera around, and then with Uh, with the latest generation, there's even force sensors on the arms, and so you have this force feedback and so, uh, so this is like real-time analytics like they like they did in basket like you talked about basketball at the beginning, right? But like, you know what shots, you know, the high percentage moves, you know, when you're wasting time, you know that this tool I put this tool in, didn't work. I took it out. So that's, that's really different data than any of us ever thought about surgery, like thinking about waste in a very different way. That's right, yeah, and it, I think, you know, the, the company has the data, but it really will depend on the surgeon partners to implement that data properly to develop kind of new techniques and new ways of doing things and new ways of Applying force during force feedback, um, you know, applications where we can maybe do gentler surgery with the help of technology, which, you know, that, that's one of the frustrating things about teaching residents, you know, at the beginning. Uh, they're just not gentle with tissue at the beginning. Oh yeah, oh yeah, yeah, so, yeah, yeah, yeah, we, we've all, we've all been there, we've all done it ourselves when we were interns and residents, um, and so, you know, that that's, that is one of the really gratifying things about, you know, being in a teaching institution, you see your residents from the beginning and you see them graduating as chief residents and you're like, wow, that's really awesome that they're really good surgeons now. But yeah, these technologies, if we apply them and leverage them the right way, it can help us to have uh surgeons learn surgery faster and maybe even better in the long run. So, um, yeah, so that part's really exciting, um, and then, yeah, no, there's a lot of changes in prostate cancer, um. The, the idea, which I find really comforting is that uh we can do a surgery now which really helps the guys to get back to their normal level of quality of life actually really pretty quickly. Um, and then the, um, additional therapies like radiation and the different medications out there, even if we, you know, in the smaller percentage of guys aren't able to get all the cancer out because it's spread someplace already, that those guys will actually still live a long time and so um with a really pretty good quality of life and so the whole face of prostate cancer is changing. Um, very different than when I started out doing this, um, and so I, I think the future is really bright as far as, um, the outlook for men with this specific type of disease, and yeah, and like I said before, we can watch a lot of men and they do really, really well. And so, um, and these new technologies will hopefully help us to pick out those guys who need treatment sooner, don't need treatment at all, and then we can be smarter as far as how we select guys. It's really exciting. Um, as you look back, you know, what, what advice would you give to your younger self or, or what surprises, you know, what would you give to somebody, the trainees that you have, um, as you've seen your career evolve? Yeah, no, I, I think that, um. Even so, one thing that I've seen a lot over the years because I've gone and helped other surgeons learn how to do robotic surgery, and then even like my partners who I work with on a daily basis, a lot of us still do things the way that we learned when we were residents, um, you know, the way that we were trained, but I don't do anything the way that I did when I was a resident, right, because it's completely different. And so I think, um, I've tried to embrace that. Um, I think it's, it's a really good lesson, um, if you really believe in something, because, yeah, my initial like job applications and interviews were a little discouraging because, yeah, no, nobody at the like, Academic institutions wanted somebody who was going to do robo prostatectomies, but I thought, oh, this is gonna be a really big thing. And so, um, just kind of pushing through that and um doing what you believe is going to be better for patients and then even now switching to single port and applying that for patients, even though that learning curve was really uncomfortable. I, I, I'm really seeking the value of that uh for certain applications and so, yeah, kind of. Keep pushing yourself, uh, being uncomfortable is OK, and that's probably a sign that you're doing something right. I love that. Thank you both so much for being with us today. Thank you. Yeah, this is a lot of fun. Appreciate it. This has been Physician Huddle by UCI Health. Thank you for joining us. This was an episode of the Physician Huddle podcast by UCI Health, produced by Brett Shaheen, Angelika Yogubi, and Victor Ting. For more episodes, information on clinical trials at UCI Health, or to refer a patient, review the show notes or visit clinicalconnection. UIhealth.org. Created by
