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Can a DRs open surgery experience compensate for a lack of robotic experience?

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Posted 8/19/2009 6:34 PM (GMT 0)

I am wondering what you guys think.

An aquaintance of mine, newly diagnosed with pc was considering having Da Vinci surgery with a very well known and experienced Dr. from MSK. However his experience is mostly with open surgery. The nurse told him that his Robotic experience is about 100. I know that the recommended amount is over 300. Do you think that his experience with open surgery can compensate for his lack of robotic experience?

Thanks for your thoughts.

Posted 8/19/2009 6:50 PM (GMT 0)

Hangin-in

When I was trying to decide on who I wanted to perform my DaVinci surgery, I considered that my urologist, who I love and by whom I'm still being followed, had only done 30 robotic operations, even though he had a ton of experience with open. To his credit, he referred me to two other surgeons who had done 750 & 2000 robotics respectively (including the guy he trained under). Coupled with the research that I had done, it became apparent that overall experience and specific experience were not one and the same. I chose the surgeon with 2000 under his belt, and would have been comfortable with the 750 guy as well...........just one man's opinion.

Arnie in DE

Posted 8/19/2009 7:10 PM (GMT 0)
Dear Arnie:

While I ultimately did not choose surgery, I did do a ton of research into the options.  If it was me, the answer would be NO.  I would have gone da vinci but with a guy who had done hundreds of procedures...not 100.

Tudpock

Posted 8/19/2009 7:19 PM (GMT 0)
Hi hangin-in,

Only MHO but, unless a surgeon is fully experienced in a specific procedure, other procedures don't necessarily count. An associate of mine with PCa, ex-mil pilot, said 10,000 hours on a certain aircraft is great. Those other hours don't matter much when trying to competently fly a Raptor with only 20 hours experience. Those were his comments, made when we were discussing open vs robotic PCa surgery. Again, IMHO, I would consider someone with at least 400 robotic procedures. However, I don't believe that (robotic) would have been a good option for me.

Mike
Posted 8/19/2009 7:34 PM (GMT 0)
I would answer that with a resounding no. He may be great with the open surgery like I had, but has too limited experience on the robotic. Experience on one doesn't count apples to apples on the other. Same surgerey on paper ,but two entirely different approaches and experience required.

david in sc
Posted 8/19/2009 7:41 PM (GMT 0)
I have no idea how many surgeries my Robotic surgeon has done. (and I came out pretty well)  If I went down that road, I’d also be interested if he:

recently separated from his wife
recently had a death in his immediately family
how much alcohol does he consume the night before surgery
lost any favorite pets
have any teenage kids he can’t control that are driving him nuts

The list can get pretty long and since there's no way to gague how well they deal with any of these issues......

I trusted my gut and liked the surgeon...

Posted 8/19/2009 9:26 PM (GMT 0)
Minimum of 500 and 1,000 is better. I would never have someone with at least this experience operate on me. As my doc said, why would you even think about getting the 2nd best when the best is available.
JT
Posted 8/19/2009 9:38 PM (GMT 0)
I have to agree with the rest of the guys. It is a mechanical technique. Takes tremendous eye hand coordination. Practice on the other 500 giys is important before he gets to you. Mine had 750. I am sure I would have a positive margin if a less experienced guy did it. Someone posted on here that a surgeon left 40 % of the prostate in on one unlucky fellow.
Posted 8/19/2009 9:52 PM (GMT 0)
My surgeon told me he had done right at 100 surgeries with the robot. My surgery went very well. I don't see how it could have been any better. It's been 24 days since my operation and I dribble very little. I've had several erections and could have had intercourse if I had been cleared to by my doctor. I was up and walking about 5 hours after I woke up. I think it depends more on the doctor's training leading up to the surgeries than a specific number. Some people just learn faster and are more competent than others. I'm not sure what his experience is with the open procedure. I think that almost all his surgeries are robotic. The hospital in my town just got the Da Vinci machine a little over a year ago.
Posted 8/19/2009 10:14 PM (GMT 0)
I would say that humility wins every time. My uro had done 500 and told me I should talk to a colleague who had done 2,000. I went with the 500 because it seemed to me he was paying attention to every operation and trying to do better. So, to me, the issue is not so much how many your uro has done, but how he feels about continuing to get better. Your descrioption would make me worry.
Posted 8/19/2009 10:28 PM (GMT 0)
Hey Riggerjon,

I wouldn't waste too many of those things. Just don't habg from the chandeliers !
Posted 8/19/2009 10:32 PM (GMT 0)
geezer, i tend to agree with you. t he sheer number of operations shouldn't be the single deciding factor. there could be lots of sloppy operations for the money, or it could be a production assembly line clinic. a good surgeon even in the 300-500 range can be expertly experienced.

david in sc
Posted 8/19/2009 11:57 PM (GMT 0)
While I agree that some surgeons' learning curve are faster than others, and the actual number of surgeries may not be as important relative to that, it's the unexpected situational difficulties a surgeon might encounter that would lead me to someone for whom there are no surgical "curveballs"...the more one has seen, the less chance there is of any surprises. Also, I posed the assembly line question to Dr. Lee, and his response was "the day it becomes assembly line is the day I quit" because of the above stated reason...........My uro responded "why wouldn't you want to be the 2000th patient down the line"

Arnie in DE

Posted 8/20/2009 1:57 AM (GMT 0)
    I did not find HW until after my RRP (open) surgery was over.  But, I'm still not sure I would have changed my decision eventhough I had a long LEAKY bumpy road with recovery.  My Uro did my surgery.  He had about 300 under his belt at the time.  I liked the fact he and his associate URO were both about my age.  I felt that they could easily see themselfs on the table in my place.  He fully understood all of my concerns.

    One thing I think about the number count is that sometime it is some sales pitch!!!!  Also,  some of the high number guys are at "teaching" hospitals.  Who is to say that they are the ones at the table or driving the robot when your lights go out?

    Good Luck with your decisions.

    KW 

Posted 8/20/2009 12:37 PM (GMT 0)

Thanks for the posts. The discussions on this site has been very helpful to me.

I think that experience is the major factor but certainly other factors such as "care", "humility", "striving to do better", etc must be taken into account too.

For me, deciding which Dr to go with was the hardest part.

Posted 8/20/2009 1:07 PM (GMT 0)
Majority of articles state that the Davinci has a high learning curve. I found three videos on the web of the ACTUAL Surgery. One thing I immediatley noticed was that with two of the video's the robot movements were very 'jerky' which surprised me. When I watched a video of my surgeon performing I believe it was 270th operation with DaVinci at Vanderbilt I actually commented outloud...The movements are so smooth. I would and did go with experience.
Posted 8/21/2009 1:47 AM (GMT 0)
My surgeon had only done 50 and am fine. I agree with Steve n Dallas, there are lots of things to consider.
Posted 8/21/2009 3:15 AM (GMT 0)
MSK has a number of experienced DaVinci surgeons. Why go with someone who is just learning?My wife's cousin had a DaVinci surgery there. He is very happy with. I think the doc's name was Dr. Colman. He even wrote a letter to Scardino to express his thanks. He is an MD, BTW.
Posted 8/21/2009 3:31 AM (GMT 0)
This is a hard call, but I think it all depends on the surgeon.

I believe that open surgery and robotic surgery still have nearly the same outcomes with competent surgeons.

The one benefit I've heard from several health care professionals is that robotic may have lower blood loss for some patients as compared to open surgery.

Barry
Posted 8/21/2009 7:26 PM (GMT 0)
I think Steve in Dallas said it well. There are many variables. 100 prior da Vinci surgical procedures doesn't indicate lack of proficiency. Other factors/variables are important to consider, also. I know I wouldn't have a surgery by one of the guys who reports thousands of procedures in less than 5 or 7 years, though - too dangerous to risk it IMO.
Posted 8/22/2009 3:16 PM (GMT 0)

My urologist told me straight away that his experience is with open surgery and at this point in his career, he was not interested in taking the time to learn the robotics procedure.  He was also concerned that some robotics surgeons treat the operation like an assembly line and are only in it for the money, and he insisted that if I choose the robotics surgery, I only go with someone who has done at least 500 of them.  When I interviewed Dr. Esposito, who did my surgery, one of the questions I asked him was whether there would be any circumstances where he would tell the patient not to have surgery but to have radiation instead.  His response was, "the way I was trained, what's most important is what's in the patient's best interests:  I'm a doctor first, a urologist second, and a surgeon third."  My point is, yes, you want someone with experience, but what's at least equally important is the character of the doctor.  That's why some opt for the open procedure over robotics.  Trust your instincts.

Greg

Posted 8/22/2009 4:55 PM (GMT 0)
Greg, great post, your reasons are why I had open surgery, and my dr/surgeon had the same priority list when discussing treatment options.

david in sc
Posted 8/23/2009 3:14 AM (GMT 0)
Hi Greg

I had similar problems in Thailand one doctor had 100 robotics under his belt and a doctor that was not against Robotics but see no advantages in it so he will not do them at the moment The robotics doctor was giving me the hard sell telling me that he could do them in under 90 Min's the open gave me the impression that while he would be happy to do surgery on me it was completely my decision and made me feel very comfortable with him I went the open route and at the moment all is well no pads after 12 days (not completely dry but very nearly) do not think that I have any ED problems but really to early the find out for sure but early signs are very good and I had very little pain at all and the surgery was 60% cheaper than Robotics so I feel very lucky that I had done my homework and although I first wanted to have Robotic surgery I kept an open mind until I had looked at all options

Colin
Posted 8/23/2009 3:56 AM (GMT 0)
Colin, glad you are still doing so well. The important thing is that you did get opinions and weighed them out yourself. The method, robotic vs. open is far less important than the skill of the surgeon, as discussed often here, and the comfort and trust factor that you, the patient has with his doctor. That is talked about less for some reason. I am definitely a first impression kind of person by nature, if I get bad vibes or gut feeling on someone, I rarely if ever change my opinion about a person. Not saying that is good or bad, right or wrong. I am very much that way with doctors and other specialists. When it comes to subjecting myself, my body, or possibly my life in light of a medical or surgical matter, those gut feelings of mine are going to be the deciding factor with me, despite stats and percentages.

You living in an Eastern country far from the United States, made your decision process even more difficult but interesting to say the least. I admire you for working through it, getting the answers you needed, then making your primary treatment, and then of course, following through.

I sincerely hope your post surgery positives continue in that direction. You got to be feeling pretty good about things so far.

David in SC
Posted 8/23/2009 5:29 AM (GMT 0)
David I am some what the same as you I make opinions very quickly sometimes for the good as well as for the bad It was something that worried me with the Robotics doctor from the word go but I had 3 meetings with him what really turned me against him was when he said that he could do the operation in 90 min's I was concerned that he was more interested in doing them quicker that anybody else where as my open doctor was not at all concerned how long it took in fact it took over 5 hrs and in Thailand he does them after his normal consultations at 4.30pm and his morning rounds were before 6am and I think if I had known that before I am not sure that I would have let him do surgery on me

On a side note I am so glad that I have learned to keep an open mind about people and not go by first impressions only because I did not like my lady at first I thought that she was a stuck up cow boy how wrong was I and over 2 years and a baby boy later she is nothing like it and is more down to earth than me
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