Comparison of robotic vs open prostatectomy

I am sure that robotic vs open prostatectomy has been debated ad nauseum in the past on HW. I hesitate to even bring it up. But, it seems there are very few, if any, new members that post here and are considering an open procedure now days. It seems as if robotic is fait acompli going into the future. As a reminder to some, there are still many gifted open surgeons out there and excellent results can be achieved.

For anyone considering open surgery, don't dismiss it out of hand. I had open surgery a little over a year ago. My urinary control is perfect. My underwear is as dry in the evening when it take it off as when I put it on in the morning. I don't leak or drip when I cough, sneeze, laugh, sit, stand, squat, lift, bend over, or have sex. I know i am probably lucky in some sense but I do give credit to my surgeon for doing great work that helped me get this result.

I gave open Surgery some real consideration but went with the Davinci praying that the better vision and precise tool control would somehow improve my odds regarding both issues without any definitive study to go by. My conclusion was based upon the research I performed and the fact that my PCa was caught very early on. If I had a more advanced cancer, I would have gone with open surgery. In doing my research and talking to various doctors what I learned is that a surgeon performing open surgery can tell by feel if a nerve can be sparred or needs removal by the hardness in the area. It is my understanding that this feeling for hardness extends to other areas around the gland's pocket too. My primary uro performed about 40 robotic surgeries and went back to the open method simply because robotic surgery lacked the tactile feed back he uses during open surgery to make decisions on the fly. One statistic he cites is the fact that nationally, positive margins have increased from 2% to 6% from 2005 till today. Also, 2% was a historically level figure before 2005 and 2005 was the date the Davinci was approved for use by the FDA. That is a three fold increase, and while not direct proof that the cause of the increase is the increased use of the robot, the increased use of the robot has been the only significant change in the theater of operations within this time frame.

I posted this here because it took reading and talking to two professionals to put this all together. Not one of the uros that I talked to took the time to provide me the complete picture, and I talked to 3 uros, 1 radiologists, and my GP. My primary uro gave me the stat about the increase in positive margins since Davinci's introduction. When I raised the question of tactile feed back and the increase in positive margins to a uro that specilizes in robotic surgery, he asked me if I could tell if his desktop is hard by just looking at it. I answered yes, but I said to myself that I know this because I know wood to be hard. I don’t know of any wood inside the human body. I was also wondering why he asked me that question. After doing some reading I discovered the surgeon is able to make adjustments on the fly based upon the feedback of hardness. I also believe this feedback coupled with a skilled open method surgeon could really help one improve his life if the cancer has spread outside the gland. With a preoperative gleason of 3+3, my primary uro assured me that the cancer was contained within the gland. I also know of two men that were happy with the davinci and knew of no one that had the open. IMHO, if my gleason score had been higher I probably would have gone with my primary uro and open surgery. My surgery was performed on Jan 3rd, 2012 and it is way to early for me to make a guesstamate on my recovery.

Post Edited (Desertrat1) : 1/12/2012 8:43:09 AM (GMT-7)

That study, while just announced covered a period over 3 years ago (August 1, 2008, through December 31, 2008).

Curious to see what that study would uncover if done now, Robotic was fairly new 3 yrs ago those same Dr's have many more procedures performed since that atudy

Funny to see they say "Medicare-age men" not many 50-62 yr old men are likely to be part of this study.

I had open and after almost 2 years it's 6 pads, no nerve bundles, constant urges. I figure the percentages are always 50-50. Either you have lousy results, or good ones. Naturally, everyone who is not satisfied is a member of the shoulda woulda coulda club.

There are good arguments for both methods, but I feel the way that doctors and hospitals market the robot is a bit misleading and biased at times, and they know that with men patients, they are often more interested in the "hardware" side than the medical side.

The arguments about tactile feel that only comes with open surgery has a strong pull to it. The magnification side to the robotic side is often overstated, as many open surgeons use state of the art hoods with magnification.

I have read early reports too, not the one in this thread, that at surface value, open surgery had both an edge on incontinence issues and even possibly ED issues.

I would love to see a poll, of those that had nerve sparing robotic surgery, who ended up with long term ED issues. I have a feeling I know where that number would be.

As far as hospital time, even that varies. Some open guys are ready to be released in 48 hours, and some robotic guys have stayed that long. If you have good insurance and you aren't in a big hurry, I don't see that as an issue. And if you have complications, I would rather be in the hospital longer. I spent 4 1/2 days.

The ultimate key, is in the hands of the particular surgeon, his general experience level, and his ability to deal with complications and problems if they arise. The method is secondary. But someone has to pay for these mult-million dollar robots, that's for sure, so its easy to see why they are being pushed so much. Who does that really benefit the most?

david in sc

They take out the pituitary gland through the nose. Maybe with a longer arm on the robot they could get the prostate out as well. Ouch!

postop - that hurt just to think about that, lol. that would be one long robotic arm to do what you suggested

Reading these results I am thrilled I avoided surgery and decided on Hyperthermia in St. George Clinic in Bad Aibling



I strongly believe before surgery any every guy should read "the Invasion of the Prostate Snatchers" by Dr. Scholts
Ezra

I had robotic. I interviewed 3 surgeons and a radiologist before making my decision, (the radiiologist recommended surgery), and in the end I went with the surgeon I felt most comfortable with, who happened to specialize in the Robotic.

As of today I am leaking at a rate of 1-2 pads per day, dry at night, and struggling with ED.  I dont think my results would have been any different had I gone the other way, and even so, theres no lookingback anyway. 

Bronson,

It's funny, I didn't have dyslexia before the surgery! I've been <.01 on every test since the removal, 21 months ago. Time to fix my signature. Thanks! Have a great 2012 as well. We started by moving from BC to Hawaii. Walking around in a bathing suit all day really cuts down on pad usage!

dick,

a positive margin does not mean you will have recurrance, thus needing RT. some guys with positive margins never have a problem. i had one, very tiny, yet had recurrance declared within 9 months of surgery. if it were me, i would wait till you saw real evidence of it becoming a problem. RT or SRT is a serious step, and you would want to make sure you really needed it before committing to it in my opinion. i hope you never have the need.

david in sc