Doctors Need 1,600 Robot-Aided Prostate Surgeries for Skills, Study Finds

Tony, my point here was nor who has done the most RRP's, but you did confirm that in the country, there are but 5-6 doc's that can claim to have done more than 3,000 procedures.

My point is that when a junior partner to one of the guys who does this many (Tawari) writes a report claiming that you need 1,600 op's before you're proficient, the report is both self-serving and absurd. There are local and regional hospitals getting DaVinci machines and this is eating away at the "prostate mills" (as I like to call them....flame away!) business.

Want to bet Tawari has been experiencing a drop-off in new patients and suddenly his junior partner issues a report bolstering his bosses experience. Just my guess here of course.

I will state that I know of two men, and spoken with both, who contend that Tewari walks on water. He operated on both and they each had excellent outcomes. I'm not diminishing his skills, just postulating that when you earn several million bucks a year doing procedures, you are likely to want to protect your practice and income stream.

thank you, brain surgeon, for putting some common sense back into this.

i am not a dr like you, but i have repeatedly said, that its not a numbers game, that quality is more important than some number, whether it be 500 or 5000.

I hope your answer balancing out some of the extreme thinking here on this subject.

My wife and I are flying home to the Chicago area from Puerto Vallarta today.  What if some veteran pilot came out with a study claiming that it takes 1600 flights to become proficient on a 737?  There may be some truth to that, or it may be fiction.  But, when you board a jetliner, do you know if the pilot has 500 flight hours, 2000 flight hours, or maybe just 10 flight hours under his belt?  And, if you don't care about that, then maybe we should stop warning people away from excellent surgeons with a low number of surgeries.  Excellence is the key, not numbers, and the two may or may not correlate in the case of any particular surgeon.

How do high volume surgeons achieve better positive margin rates?  Have they finally learned to cut wider, or what?  I'm not sure I understand that.  Or, are they just more selective on whom they accept as patients?

I still feel that if it takes 1600 surgeries, or even "only" 1000 to become proficiient, then maybe someone should step in and call a halt to this procedure.  Again, using the loose analogy of the pilot, if it took 1000 flights to achieve proficiency, that person wouldn't be at the helm until he had that many hours either in a simulator or as a co-pilot.

 

The fact that my young surgeon had "only" performed 330 robotic prostatetomies explains why I still have cancer (maybe) and I'm impotent..My Gleason 9 and PSA of 14 could not have had anything to do with it....Would the fact that he warned me upfront that there was only a 50% chance of success improved if he had done 1600 or more procedures??

Does every surgeon produce 1599 patients who must endure sub-standard surgeries as part of the cost of treating prostate cancer????

The "Top" surgeons get 50 calls a day from people all over the country begging for their services..They can pick and choose who they accept, have several "gatekeepers" to ensure only those with the best chances of a cure are accepted..Their legend grows and grows..Now, lets write a book promoting the new multi-million dollar surgical center that will be named after them..

Fairwind said:

"The "Top" surgeons get 50 calls a day from people all over the country begging for their services..They can pick and choose who they accept, have several "gatekeepers" to ensure only those with the best chances of a cure are accepted"

I'm not sure where that comes from. I can find no evidence though I have heard some of the online folks in forums say it. I'm sure it's possible but it was not the case with my surgeon. You can check my signature for my clinical information and I assure you that I would not have been that type of patient. In fact, in watching the presentation Thursday it was quite the opposite being said. This surgeon outlined that the patients that will likely reap the most benefit with a radical prostatectomy are those with intermediate and high risk group characteristics and patients that had lesser characteristics should consider less invasive therapies than RP including active surveillance. He outlined the following points:

1> Biochemical failure after RP is easier to detect and easier to treat and there is relatively little controversy as to what to do in such cases. This is important for the intermediate and high risk groups.

2> Biochemical failure after other forms of therapy such as radiation or cryo are difficult to treat and there is much more controversy on how to proceed. Low risk group patients are less likely to face that controversy.

If Dr. Wilson was looking for patient screening to make his cases easier he would not have operated on me because it was quite clear that my clinical data did not meet that standard. Interestingly, my PSA dropped out even after surgery even though my pathology characteristics indicated I have advanced prostate cancer. I had to add the controversy by completing adjuvant therapies.

Tony

As I have stated before...I am sick of all the status given to the mega surgeons.  I put those 'surgery mill' doctors in the same class as snake oil salesmen.    Doctor like the Menons, Tewariis, Samadis and Patels  diminish their worth by performing so many assemblyline procedures. They do it for the bucks $ and nothing more.

I think we all agree that experience is a good thing.  However it is ludicrous to assume that 1000's of surgeries are needed to be proficient.  I, for one, would never set foot in a surgery mill.

lifeguyd, that's exactly what my R. N. wife has been saying since this thread started.

Since we all know that the stakes are high with the RP procedure we want to make sure we do everything we can to give oursleves the best chance.

I remember as a teenager working as a pool lifeguard and my supervisor had a somewhat fancy waterproof watch that needed a new crystal. I told him that I knew a top-notch jeweler that could replace the crystal. Sure enough, when this experienced jeweler was replacing the crystal his hand slipped a little and he put a little scratch on the watch face.

I asked my surgeon if he could visually "see" the malignant cancer cells as he performed the da Vinci RP. He replied that he couldn't see the cancer but he could see the nerves that I wanted to spare.

I knew then that there would be a chance that I could have a positive margin depending upon where the tumor happened to grow. But I also thought there was good chance I would keep my nerve bundles.

I agree with much that has been said here regarding the odds of having a positive marging versus how advanced the PCa is. If the surgeon is unable to see the specific cancer cells and your PCa is somewhat advanced then besides the surgeon skill level, the luck of the draw has a lot to do with getting it all out.

Holy smokes! 1600! My Dad's doctor does 2 a week (Da Vinci) -- I thought he said he had done over 800 and supposadly that was really good. They don't call it "practicing" medicine for no reason .... they are always practicing and trying to perfect!