 Well, thanks for having me. Is there anybody in the room that hasn't had surgery yet? Anybody that's had surgery that's needing another surgery? I'm not selling myself. I'm simply asking because I think a lot about recovery after surgery has to do with what you were expecting before surgery and the conversations that you had. And learning about what it is that you have before surgery. I mean, the way this ends up happening is oftentimes the patient will find out that they have a tumor and they'll show up and they will have done their due diligence and reading a whole bunch of stuff before they get to you. And in their mind, they have it what I need. And really what has to happen is need to look at the patient, look at the tumor, and figure out what's going to hurt you worse. Is the surgery going to hurt you worse? Or is the treatment going to hurt you worse than the tumor? That's kind of what Dr. Smith was talking about before. Sometimes you don't need treatment right away. Sometimes you don't need treatment at all. And sometimes, obviously, you do. And that kind of is where we lead into recovery. Expectations of recovery. Recovery is multifactorial. The tumor factors that help dictate the surgery you have or maybe don't need. And then the U factors, which are described by your functional status, your mobility, your general health, your nutritional status, motivation and expectations, realizing that maybe the most important factors about recovering from the surgery don't have to do really with the surgery itself. Maybe they have to do with getting up and about, realizing that healing is more about moving in healing rather than sitting still in healing. And also the emotional readiness for what it is that you have and what it is that you're getting ready to go through. Because largely, this is hitting people like a brick wall. It causes me to examine my own life and realize that I can't simply plan for when I'm 65. I tell my parents now, save your money, but don't save all of it. Because a lot of times, you're just not ready to hear that this is what's happened. And it's a process of learning about the disease, meeting other people that have it, meeting other people that have had successes, and understanding what the future holds. Well, that color didn't come up. This is a Mac 2 PC process. But really, what this was pointing to, well, that was worse, these were tumor factors. So location of the tumor, the size of the tumor, whether it's localized or metastatic, those factors are going to help determine what it is that one would need, if anything at all. And how extensive that treatment is going to be from the very beginning in terms of evaluation on through months and years later. There's the surgery factors. Is it going to be an open operation? Is it so big in encompassing the big blood vessels of your body that we have to put you on cardiopulmonary bypass? We're going to do it laparoscopically, and the complications that are associated with it. And what I tell patients about this is I liken it to a hobby of mine which is driving cars. I've driven a little race car for over 10 years now at this race track up in Virginia called Virginia International Raceway. And most of the weekends that I go up there, there are a lot of hobbyists like myself that are there just for the weekend. We have other jobs. And we just like to get the speed out of us on a race track in a pseudo-controlled situation. And then there are other folks that are there that are training to be race car drivers. And there are people that actually are racers. And they end up being teachers at these camps that we go to. And it's pretty easy to realize, you realize early on that you could take the true racers and put them in cars that are half the car that your car is, and they'll beat you around a track. It doesn't so much have to do with the car. At some point it does, but it doesn't so much have to do with the car as much as it does the driver. And really what you need to do is you need to find persons with whom you develop good relationships and that you feel confident with and you move forward with them. And not worry so much about, are they driving the robot car, are they driving the lap car, are they driving the open car, are they feel comfortable with your caregivers. And then there are the you factors, such as your general health, your performance status. Performance status and general health kind of go together. It's more about how functional are you, how active are you. These things are gonna play largely into your recovery because we're gonna need you, or you by virtue of being here, realize that you are needed to walk a lot. I mean, your surgeon's probably driving you nuts asking you how many times you walked. Your nutritional status, your exercise tolerance. And later on we'll get into hopefulness. But exercise tolerance is one that plays in more commonly here in North Carolina. I did my fellowship at UCLA and I like to claim that, and I was telling folks at the table today that I rarely operated on somebody less than, more than 220 pounds in LA. And in North Carolina I operate on lots of folks that are over 220 pounds. And oftentimes your prehabilitation, if you have an opportunity to prehab, affects your recovery after surgery. So if you can learn to develop some exercise tolerance, walking a couple miles a day, every day. Anecdotally, we know that this patient, we feel that those patients do better. There are the tumor factors, and Dr. Smith spoke about this. Not every two centimeter mass is the same. You could have a two centimeter mass in a 90 year old that may or may not have a lot of comorbidities, but they're 90 and they won. They won the game of life, quite honestly. And that two centimeter mass was generally more than 90% of the time found by accident and isn't hurting them. But I know that I could. And so maybe we don't need to risk it by intervening, and that's where active surveillance comes in. And again, that's a shared decision. And you have the two centimeter exophitic mass in the 45 year old, and you have to balance what's the risk of me or any treatment versus the risk of that tumor over time. And largely for 45 year olds, we're gonna wanna intervene because there's a long surveillance period associated with it if you don't. And oftentimes when you treat a small renal mass in a 45 year old patient, they do extremely well, and that's the end of that conversation. You can have a two centimeter mass that's endophitic, meaning entirely within the kidney or largely within the kidney, that's in the only kidney that the patient has and they're 45 years old. In that case, you're gonna be wanting to make every effort you can to preserve the function of that kidney while removing the tumor. That's again different from the two centimeter entirely within the kidney, but a non-functional kidney and a patient that has two kidneys that's 45 years old, that operation's different than this one. This is a partial nephrectomy almost mandatory. This is likely a radical nephrectomy that's probably most certainly less complicated than this. That patient will oftentimes have lower likelihood of complications and maybe even recover faster. Oftentimes this patient's going home the next day. You could have a 20 centimeter mass foot long in a 45 year old and that operation's completely different from any of these other ones that we've talked about and that recovery's gonna be different. And you could have the patient that has the thrombus that's entering the big veins in their body and maybe tracking all the way up to their heart, even more complexity. So different operations yield different recovery processes. You don't need to go to medical school to see that there's something here that probably isn't supposed to be there. And then here you have this small renal mass. So the treatment for these two tumors is gonna be largely different and the recovery is going to be congruent, concurrently different. Some of it has to do with incisions and again this is where I get back to getting the driver, working with the driver and not the car. Maybe it's appropriate if you need a robotic partial nephrectomy. I say that I did a fellowship in surgical oncology, not a fellowship in knife. If we need three one centimeter incisions to take your tumor out we're gonna do that. If we need one two foot incision to take the tumor out that's what we're gonna do. So yes robotic partial nephrectomies are preferred for small renal masses when appropriate and when feasible. And recovery is definitely different than if you have a large incision. You could do a pure lap nephrectomy where we make small incisions. When we're trying to remove the entire kidney and we extract the tumor generally from a phantastial or low abdominal incision. You could have a hand assisted lap nephrectomy where you have a couple small incisions and then one to get the tumor out up here where you also place your hand to help assist you in the dissection process. Maybe the tumor is larger or maybe the patient has had a lot of intraperitoneal surgeries or maybe the patient has had dialysis and this is a non-functional kidney that has a tumor in it and once you've had dialysis or a lot of operations in the past inside your belly within the sac that contains your intestines, there is a lot of scar tissue and perhaps you wanna stay out of that so you perform a radical nephrectomy through an incision. And then you could have a big tumor like we were talking about before where we're gonna make an incision all the way essentially from your armpit across to the midline and all the way down to your pubic bone and it ends up being like a Pillsbury docan where you pop the thing and it goes and that's what we do to you but that was what was required. So then what's the typical recovery? Typical, everyone's different. It may be five days for me and maybe three days for someone else. For a robotic partial nephrectomy, a lot of times the majority of the time the patient's in the hospital for one to three days. We tell them light duty for two to three weeks, resume regular duty, probably about four weeks and I use this terminology forget. When do you start to forget? And the reason I say that is because you could be sitting there having forgotten that four weeks ago you had surgery but you turned to pick up this glass and all of a sudden you're reminded because you're still healing and you pull on your belly and you feel it. So for open partial nephrectomies which are generally for the more complicated partial nephrectomies, the patients in the hospital for about two to four days, we tell them to stay on light duty at about four to six weeks. After six weeks, before six weeks we ask them not to lift anything more than 10 pounds and after six weeks we tell them they could swing a golf club or do whatever it is that they were trying to do before. Another thing that I tell them is that God or whoever it is that you're believing in is going to tell you what you can and can't do. If it hurts, don't do it. And eventually that should hopefully go away and you tend to start forgetting at about three months. For a pure lap, laparoscopic nephrectomy where we're just, we're gonna put the small ports in, we're gonna remove the kidney. Usually you're just in the hospital overnight. You resume light duty in two to three weeks and you resume regular duty at about four weeks. A hand assisted laparoscopic nephrectomy is about the same, just a little longer. Big open nephrectomy depends, depends on what happened and what was required. Spend it up to a week in the hospital four to six weeks before returning to work, three to four months before you forget. It can be more depending on what was involved in the operation. So all of that, we tell patients and we've been telling patients that for a hundred years, not that we've been doing all of these operations for a hundred years, but just that, I mean, this whole six week thing, no lifting greater than 10 pounds for six weeks. We've been saying because the person that taught us told us to say that and the person that taught them told them to say that and a hundred years you can go back 115 years. And that's what we've been saying. And that doesn't really matter as much as one factor that's impossible to measure. It's amazing how hopefulness is disproportionately important when it comes to recovery. Patients that I could put the biggest operation down on people and the majority of what I do is kidney cancer, do these huge operations in patients. And they oftentimes will be very hopeful, hopefully because of what things like Dr. Harrison and I have talked to them about, but they do well. No idea why that is, we call it the placebo effect and a lot of things that we do, but it's really hopefulness. And the belief that you're gonna do well, those patients do well. The patients that think that they're not gonna do well are overly pessimistic, dark, that I'm trying to get out of the darkness before we go into surgery. And I'm not talking about that day, I'm talking about days and weeks beforehand. Something's gonna go wrong. So hopefulness, there's this intangible quality of hopefulness that we can't describe, we can't measure. And all we can do is try to inject in the conversations that we have with patients. We've all, that treat kidney cancer, we've all seen the patients that should have done not so great that have just flown and years and years and years and years later. We've seen all the home runs that we've had and a lot of it has to do with reasons that we can't explain yet. But maybe we'll never be able to explain them, maybe that's the part that the patient brings by virtue of their personality and their support system and the experiences that they've had in their lives, maybe the faith that they have. So I think that's an important part of recovery that we don't talk about a lot. And the reason we don't talk about it is because there isn't a survey for it and there isn't a lab for it. If you have any other questions about anything, I heard a couple of people talking about their conditions and where they stand in their disease process. And if you ever have any questions and you just want some off the cuff advice or conversation, you can always get in touch with me. That's it.