Robotic Surgery Is Questioned in New Study

clrwtr,

since you are so particular on the exact surgeon to potentially do a robotic surgery on you, and assuming you can't get any of the ones you want, you said you would do radiation. why not just have open surgey, still the "gold standard", has been done for decades with good results, and you could work with a long list of highly experienced qualified surgeons to do it. the hang up shouldn't be open vs. robotic, thats just the methodology about the same operation. even if you went robotic and they started the operation, if complications arose, they would have to switch to an open procedure anyway. the technology or the device is not the issue here, the issue is the compentency and experience of the particular surgeon

david in sc

The biggest thing that I always wonder on the experience debate is: How many robotic surgeons are there in the US now? How many more are switching over to it and beginning the learning curve now? Most importantly, where did all the current ones find patients to gain experience on and where are the future experts gonna find patients to work on? Are there enough patients in the US to provide the thousands of times experience the robotics guys need, accordingg to our advice. There must be a LOT of men out there who had surgeons who were on their 10th or 100th or 1st time doing it, so what were their results? That's the ones I'd be interested in seeing the stats on, not a 3000 patient superstar. If we continue to advise here to get the most experienced to new arrivals here, then where are the new guy surgeons gonna get their experience- from guys who aren't as aware or knowledgable as we are on the subject? If 200,000 men are diagnosed with PCa a year, and maybe 100 a year find their way here, then that must be where the pool of practice patients is that the robotic guys find to gain their critical experience. That make sense?
Those guys are the ones I'd like to see surveyed- the ones whose surgeon had only done 3 or 30 or 90.

Hi Jeff not quite accurate 5 days (they have to account for the amount they charge) but could of left in 3 days and half a baby diaper for a week I never brought any pads and as for twins one is enought for me I am still not thinking about how lucky I have been until after next month (first PSA)

So far open is the winner at 2:1. See? I told you this was unscientific. When we get 100 or so results with all ranges of staging then we might have a hint of a chance of possibly making a slim recommendation, maybe. Everyone's surgeon has done 1000 surgeries - just ask them, they'lll tell you. So who are the 20% of guys who are #1- #200? Political prisoners? jay walkers? Just wondering.

So come on guys we need data. (I once looked at signatures on this site and found similar results - after I had robotic done, by the way.)
Jeff

This is a complex issue with more to it than simply daVinci vs. open prostatectomy.

As Tony writes, experience is a key element, but does quantity always equate to quality? 

There is the patient's own physiology to consider as well, for example, how difficult is it to tease the nerves away from the prostate? (Not all prostates are alike) 

What about the extent of the cancer, capsular penetration, extracapsular, lymph node involvement, etc?

What about a man's state of health going into the surgery?  Diabetes, heart disease, ED, and other illnesses may impact recovery.

There are many other questions that could be asked that are important considerations in evaluating prostate cancer treatment "success".

Any straw poll here would be nothing more than anecdotal evidence that is meaningless.  To be scientific a study must be well designed and involve thousands of subjects, which the study that started this thread discussion was not.

As a side note, the hospital where I had an open prostatectomy has since purchased a daVinci robot, which it is advertising to prospective patients.  Now they are pushing surgeons to use it so they can justify the enormous expense.  Go figure! 

I was dx in June 2009 and since, my head has been spinning on what to do. open surgery v. Robotic surgery or Radiation. With my stats, many have said to wait and take another biopsy. Even my surgeon Dr. Menon said to wait and take another biopsy but that might cause more scar tissue and to save nerves would be more difficult. At my age I didn't find this to be a comfortable solution. I made the decision to have robotic surgery by Dr. Menon. I'm confident in his skills as a robotic surgeon because he is one of the best. I hope I'm making the right decision getting this done now and only the path report will tell. I have prostate cancer and it's not going away unless I have treatment. Experience is the greatest factor in choosing Dr. Menon and I'm fortunate I live in the area he practices in. Dr. Menon is the greatest factor in choosing robotic surgery and not the machine. My date with Dr. Menon and DaVinci is November 17.

I had open surgery, was hospitalized 3 days, catheter for 10 days, and essentially continent a week after the catheter was out.

Jeff why not start a new thread for your poll you might get a few more people answering You might remember that I would be very interested in the results

open Surgery, Hospital 4 days, catheter 63 days, dry 30 days later, Stage 2

survey addendum

the past two days I have read dozens of articles or re=read many of them and in addition to James our moderator/s  observations re experience, there is part of the experience puzzle that must be added:

While the emphasis on these threads and in the news media seems to b e on  LEARN AS MUCH AS YOU CAN about HOW MANY DAVINCI PROCEDURES YOUR SURGEON HAS UNDER HIS OR HER BELT....

The more overriding question talked about in the literature seems to be:

WHAT WAS THE EXPERIENCE LEVEL AND COMPETENCE OF THE SURGEON IN THE MONTHS OR HOPEFULLY YEARS OF open--YES open-- SURGERY TECHNIQUES BEFORE THEY STARTED ON THE ROB OT?

There are some fears,not unfounded, that some practitioners who jump into the more lucrative robotic world are surgeons who had little or no traditional open surgery experience.

mbshine