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Da Vinci vs. Traditional Surgery

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Posted 2/23/2011 7:57 PM (GMT 0)

My HMO doesn't do the Da Vinci robotic surgical procedure - they do the traditional open surgery.

 

The Da Vinci is minimally invasive and has shorter recovery times - less pain?.  Are there other SUBSTANTIATED advantages particularly with respect to efficacy?

 

The required robotics skills and learning cure with Da Vinci is higher than traditional open surgery.

 

Any advantages to open surgery? I read that the tactile feel of "hard tissue" i.e., cancerous tissue, is possible with open surgery and may aide in evaluating non-prostrate confined cancerous tissue.  

Traditional open surgery is perhaps somewhat technically less demanding...?

 

open forum for HW comments please!

 

K2

 

Posted 2/23/2011 8:05 PM (GMT 0)
K2,

We discuss this issue here a lot. The consensus, I think, is that the success rate depends more on the skill of the surgeon than the type of procedure. Both have very good success rates.

Regarding your other questions, while both open and laparoscopic surgery allow more of a tactile sense, Da Vinci gives a high def stereo microscopic view, allowing the surgeon to see better. A given surgeon may prefer one or the other. Robotic equipment also suppresses hand tremor, though that might not be a big deal for prostate surgery. If some additional problem is encountered, you might have to fall back to open surgery anyway.

Good luck! Also, welcome.

DJ
Posted 2/23/2011 8:12 PM (GMT 0)
OK.  I'll start.

I believe the right answer is that there is a slightly longer/tougher recovery associated with the open surgery than the robotic. 

I think that the difference is slight enough that you can go with whatever doctor you feel most comfortable with and get an excellent surgery. I felt the same way before the surgery and chose the open surgery, due to my comfort with the surgeon and his resume. 

I have a 2" incision (Yes, I measured yesterday.)  I would left the fever after 1 night except I had a fever.  My intent is to go back to my job after 3 weeks. 

I spoke to my hospital roomie today.  He had robotic surgery 24 hours after me, a week and a half ago.  We compared somewhat graphic notes today and could find little if any difference.

 

Posted 2/23/2011 8:28 PM (GMT 0)
My uro spent years doing open, and switched to DaVinci (some of his partners do open only). He says the "touch" argument is not real, or at least not in his experience.

I also spent several extra days in the hospital after DaVinci, so the "estimated" time of open was not relevant.

It was explained that the hospital would want me to "bank" some blood before an open procedure "just in case" if I chose that route.

My post-op recovery was longer than many, there wasn't a specific reason, just was rough.

So other than looking like the victim of a 38 emptied in my gut instead of a sabre lunge, I guess it was all about the same -

Posted 2/23/2011 9:08 PM (GMT 0)
K2....It will be the skill of the surgeon, not the procedure that you will need to investigate the best you can. Either method has it's own advantages and disadvantages. Both are trumped by surgeon skill.

If you require treatment and surgery is your choice, and your insurance only covers open...no big deal. Just find the best surgeon you can.
Posted 2/23/2011 9:10 PM (GMT 0)
K2,
Who is your HMO?

I have heard of this before but I have also heard of cases where the first person that you talk to provides faulty information. In one case a guy on an HMO was told no to robotic and the next thing we had was a poster using the same HMO and did get approved.

Tony
Posted 2/23/2011 11:11 PM (GMT 0)
K2, the reason I chose the open surgery was that they did the pathology DURING surgery. My understanding is the pathology is done AFTER surgery with da Vinci.
Posted 2/24/2011 2:11 AM (GMT 0)
Pathology is done in a lab after staining the samples. I would not expect it could be done on site during surgery in any case.

Some surgeons have a minimum pathology done on lymph nodes - if the nodes are involved they may decide it is too advanced, and abort the surgery. My surgeon had this done. Nothing was found, so they proceeded.

Posted 2/24/2011 2:19 AM (GMT 0)
K2,

I was thinking along the same lines before my surgery, and spent a lot of effort trying to research docs who did the robotic procedure when I already had a fine surgeon who did the open procedure. After all, who wouldn't want an easier recovery, all things being equal?

Outcomes with open vs. robotic surgery are remarkably similar. It comes down to the experience of the surgeon and your individual circumstances. I don't think either method is more or less demanding; it's about which procedure they're used to. This is a very demanding and complex surgery no matter how it's done, which is why everyone emphasizes experience so much.

I found that the open procedure really wasn't that bad. I spoke to an oncologist when I was weighing all this, and he suggested to me that the little difference in recovery time wouldn't matter at all a year later. I think that's the right perspective.

One other thing. If you're a good candidate for it and your insurance covers it, be sure to thoroughly consider your non-surgical options. The incontinence and ED that often follows surgery is no picnic. If I had a do-over, I'd find out more about brachytherapy and beam radiation before making a treatment decision.

Whatever your treatment choice, find the best doc you can and trust the hell out of him. Good luck and be well.

Jonathan
Posted 2/24/2011 4:02 AM (GMT 0)
You might actually find that other factors, such as distance to the hospital, or quality of the nursing staff, may sway your decision.

DJ
Posted 2/24/2011 4:03 AM (GMT 0)
 

A few years ago open surgery was all that was around.  ....times change...  I played golf with an old time urologist friend the other day.  He said he use to do PERINEAL prostate surgery (prostate removal from an incesion between the scrotum and the anus) back in the 1970's. That's all there was then.  He told me it was a crap shoot and they had no idea if it would work or not.  In fact he said that if he was diagnosed in his younger days with a gleason 6 or 7 he would have considered  watchful waiting.  He is about 80 years old now.

Times change...we are saving more lives with better methods.  I don't expect that pca treatment will be the same 10 or 20 years from now than was 10 or 20 ago.  Doctors who who do open surgery still do a good job, but they are already 10 years behind the times.

Posted 2/24/2011 4:32 AM (GMT 0)
"Doctors who who do open surgery still do a good job, but they are already 10 years behind the times."

I dont feel this is entirely an accurate remark in regards to open surgery. There are still men that have RP's done open, plenty of them, and for reasons of their particular anatomy, need to have it done by open method. And there are other medical reasons that an open surgery would be safer for the patient. Even in my own case, though robotic was too new in my area to risk (a total of only 15 had been done at that time), due to an unusual layout in my prostate bed, a robotic surgery would have been quickly aborted had I chosen that route. There is a place for both types, and I feel, in my opinion, those two choices will be out there for years to come.

David
Posted 2/24/2011 5:06 AM (GMT 0)

Purgatory said...
"Doctors who who do open surgery still do a good job, but they are already 10 years behind the times."

I dont feel this is entirely an accurate remark in regards to open surgery. There are still men that have RP's done open, plenty of them, and for reasons of their particular anatomy, need to have it done by open method. And there are other medical reasons that an open surgery would be safer for the patient. Even in my own case, though robotic was too new in my area to risk (a total of only 15 had been done at that time), due to an unusual layout in my prostate bed, a robotic surgery would have been quickly aborted had I chosen that route. There is a place for both types, and I feel, in my opinion, those two choices will be out there for years to come.

David

 

No, it is not an accurate remark, it is my opinion.  I was trying to help others recognize that Pca treatment is and should be changing all the time.  My old Urologist friend's description of a perineal prostatectomy is a great example. He told me in great detail ( more than I wanted to hear) how it was done and how often it didn't work.

 I think it is more productive to talk about new possibilities instead of trying to defend what was done to us. I suspect that you are right that "those two choices will be out there for years to come". I hope for something better.

Posted 2/24/2011 6:28 AM (GMT 0)
I agree, from what I have read, the old perineal method of surgery was hit and miss at best, sure wouldnt want any of us in this age to go through that as the only surgical choice. Even with health care methodology, it should always be an evolving process.

The largest scar on my body is 11 1/2 inches long, from having a gall bladder removed in 1981. Can you imagine that in this time period. Now its done with 2 or 3 tiny holes. I was in the hospital for 10 days on that one, looks like a shark bite to this day.
Posted 2/24/2011 8:14 AM (GMT 0)
K2,

Many here have had either one and recovered ok. Some surgeries start out a robotic then the surgeon finds he has to switch mid-operation to open

Robotic sounds like it may not be an option at all if you look at the costs

If your Ins does not cover it, will any of the procedure be covered , Hospital, nursing, recovery, even follow ups. That can push into the $100k or more range out of pocket for going with an uncovered procedure
Posted 2/24/2011 9:33 AM (GMT 0)
Re open being out of date. Every surgeon embarking on a Da Vinci knows that if the circumstances require it he will have to disconnect the robot and switch to open. Thus the skills and experience for both are needed. So yes it is the skill of the surgeon that is going to be the most relevant factor.

The examination of tissue during surgery is not the same type of thing as lab pathology, it will be much more superficial and may simply involve something like examining the outer surface of the gland to see if it looks normal or if the tumour has broken. yes you can quickly put one or two things under a microscope including lymph glands to look for very obvious signs of cancer, but for a full picture Pathology takes time: the slides have to be prepared stained and examined slowly and methodically, and that physical process alone means it can take a day.

As for Robot vs open.

I had the robot, and my neigbour's dad had the open op when he was about 70. (He lives nearby and I see him a lot).
I was in hospital for about 36 hours, he was in hospital for a week.
He said it was nearly a year after surgery before he could stand up straight without his abdomen etc hurting, he also used to walk bent over for ages. Now I don't know why he had this trouble, perhaps it was his back, his stitches/scars, but it may have been that by being in hospital for a week he did not move around enough after surgery.
At HW we go on a lot about Exercise after surgery being vital to help recovery, as do our docs. And, frankly, I think that if you spend that first week in hospital you not will take as much exercise as if you are at home. By the end of my first week I was walking about mile every day. I had even been to the stores with my daughter or wife a few times to buy groceries.

It's not just about the surgery either:
At home I would also get up and dressed every monring and get away from being near my bed. In hospital there can be a tendency to stay in you gown and near your bed. I was also not bored or mentally stressed from being in a hospital for a week and having to follow the hospital's routine instead of my own. I was at home with my wife and daughter, I was back sharing a bed with my wife. I had privacy. I had all my own things available, books, computer, food, TV, even the view out of the window.
No. 36 hours in hospital was quite enough. (I was stuck in a hospital for over a week when aged 10 and it was awful - I wouldn't want to experience that again in a hurry)

Hospitals are also not healthy places. I know of four people who have had surgery in the last couple of years and becasue is was "normal" open-style surgery it invovled a stay in hospital of at least a week - and they all caught hospital related diseases. (I think I was also at an advantage in my hospital on that account, as it is a cancer only facility, so there were no sick people around in the sense of contagious diseases. And they also have a house rule about not visiting cancer patients if you are feeling a bit ill due to the problems so many cancer patients can have with their immune systems)

So I'd say Da Vinci beats open, but perhaps not actually because of what happens when you are on the table.

Alf

Post Edited (English Alf) : 2/24/2011 2:40:53 AM (GMT-7)

Posted 2/24/2011 4:43 PM (GMT 0)
I had open abdominal surgery at age 59, resulting in a now faded to almost invisible 6 inch scar. I was operated on at 730am one morning, in my room by noon, and discharged at 5pm the next afternoon. I would have been gone at 8am that day, but my doc wanted to remove the drain, rather than a nurse do it. I had a normal, fast recovery, walking often, from the first one 3 hours after reaching my room, to oftener and longer ones after I got home. I drank lots and lots of water while the catheter was in, flushing the toxins, debris and junk left over from the surgery. I had a short bout of raised temp 6 days after, but it was just a 48 hr. deal, and easily controlled by aspirin and antibiotics. I had little bladder spasms, was regular in 4 days, and after a week, considered myself essentially over it, except for a 5 lb. weight restriction for 6 weeks. After comparing my experience to others who have had appendectomies, hernia, gall bladder and other abdominal surgeries, I think I was well ahead of them, as far as recovery, mobility quickly and overall healing. One thing I always considered was the robot makes 5 or six one inch incisions, whereas open results in one 6 inch one, but the inside work remains the same, slice, dice, cut and remove. THe biggest difference is the cutting through of the abdominal muscle layer, but my guy did a really good job of sewing me up and I came out of it with stronger abs than before....
Wish I had asked for a 6 pack replacement for the 2 quarts I had. smilewinkgrin

Oh, the reason I didn't have robotic? A 300 mile trip to Vanderbilt, an, then estimated 76gram glad, that was 110 gms. when removed. The surgeon said if I had had robotic, they would most likely would have had to convert to open to get it out, or at least make a much larger than 1 inch opening to get the bag thru.
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