Getting conflicting advice re Open vs. Robotic

Hello all,

I am confused. I have PSA 3.9, doubled in 2 years, Gleason 7 (3+4) in one core (left apex). The biopsy was done because my primary felt a nodule. Post-biopsy, the nodule seems to be gone.

I am 53 and in very good health otherwise, with a 91 year old mother who is active.

I decided on surgery based on my hope of another 30+ years of life.

A top guy at JHU says I should get open surgery because my abdomen has burn scars in the area where the robotic implements go, but not so much lower down where the open incision is made. Perhaps he is also concerned with how the abdomen would inflate. A top robotic guy (very experienced in robotic, but not open) says that the robotic is much better in terms of outcomes and that the scars would not be a problem for him to do the surgery.

So what should I do? Get a third opinion?

I think the skill of the doctor is more important you have access to is more important than anything else.

Good luck.

Get a 3rd or more opinion(s).

The surgeon who is experienced in the Da Vinci method should be the best source of information on your situation. I would think that from time to time he has dealt with other patients who had abdominal scars of various kinds and locations so he would know what effects he might encounter in your case. As far as Da Vinci compared to open, short term you have smaller incisions with Da Vinci but in the long term, there appears to be no real difference.

Thanks for all the good advice. As suggested, I am getting a third opinion. Tomorrow (Friday) I am seeing Dr. Samadi, who I have seen discussed in this forum. I thought it made sense to talk to him because he has done both open and robot. I feel fortunate to have such good choices. I am probably overanalyzing this, but you only get one shot at it, so I want to be sure.

Mine doubled in three years and 1 out of 12 positive 4+4. I had my appendix out in 1991 and a big scare right in the way and just last year a hernia operation with mesh. I chose robotic and my surgeon said no problem... it did add 1 hour to the surgery but all went well and I agree about the 100% comfort zone you need to be in with your surgeon and I was! Good luck with your decision!  Jeff

I think you would be fine with either choice. I had open surgery and the outcome was good. I know guys that have had the robot and some did well others not so good. You certainly have checked in with some of the best. Do let us know what you decide.

Best of luck with your decision.

Cajun Jeff

Welcome to HW
A couple of points (and this is a very personal response from someione with no medical qualifications):

One year after surgery, or even one month after, there is reckoned to be very little difference between open and robot (apart from the size, number and position of the scars on the abdomen).

Two days after surgery most guys will also feel exactly the same. They'll be tired, confused, aching, recovering from all the chemicals that ended up in their blood, cursing the catheter, and leg bag, etc. And they'll really be coming to terms with what's happened.

The real issue is about how things are in the rest of the first week. And this is now very much a
personal opinion!!
After two days most robot guys are back home pottering about their houses, sitting where they want, sleeping in their own beds, waking in familiar surroundings, washing in their own bathrooms, making drinks and snack in their own kitchens, picking books off the shelves they've been meaning to read, watching TV in a comfy chair, taking the dog for a short walk etc.
Most open guys will spend those four or five days in hospital getting gradually more bored and fed up with the hospital, with the routine, with the food etc. You'll have to wake up when they say and not have a lie in. You'll be trying to take exercise by walking round the corridors. You'll see family when visiting hours permit. You'll be really fed up with the beige walls, or the green floor or the view out the window of concrete or parking lots or whatever.
You may be getting an idea I don't like being in hospital, which is true. I was actually leaving the hospital 36 hours after I arrived. Others may welcome a few days extra in hospital with nurses looking after them etc and enjoy a break. (In your case you might end up thinking about your situation in relation to your 91-year-old mom. She might be happiest knowing you were in hospital being looked after, otherwise you might find her rushing about at home trying to take care of your every need)

As for picking a surgeon, you seem to be okay with JHU. For me, once I'd opted for robot I had few choices as where I live in Holland there were only about three in the country at that time and it was more important to pick the hospital that was easy to travel too.
Not quite so important, but I've heard that all robot surgeons need to know how to do open as well as occasionally they encounter complications during surgery and have to switch to open. (Doesn't happen very often though)

However, when it comes to old scars and new operations you need to get expert advice. (My own skin scars very badly) I'm guessing that scars from burns may also not be the neat straight scars from hernias or appendectomies. Incisions in or near burns scars may not be easy or possible, especially if they were full thickness burns. Wounds in burns may be difficult to stitch and may not heal well. The abdomen swells as it gets filled up with gas during the robot and scars may make this difficult.

This is though about your medical situation and you have to make the best decsion for your situation on the basis of expert advice, and may I wsih you all the best.

Alf

Thanks again to everybody for the good advice. My plan now is to go with Dr. Rejan Butani of Lourdes hospital in New Jersey. Butani does the most robotic prostatectomies in South Jersey, over 1,000 in his career. He will be assisted by a very experienced burn surgeon who can help if there is any issue with my old burn scars. They will be prepared to switch to open if necessary, and a surgeon who specializes in open will be standing by. So I feel like all the bases are covered and it has the added advantage of being local (I live in Philly).

By the way, I enjoyed meeting with Samadi. He is quite a character. He said the burn scars were a potential problem, but he was confident that he could do it anyway. I would certainly feel comfortable going with him, but given my situation I like the idea of a team including the burn surgeon.

-------------------
PSA 3.9, doubled in two years
Gleason 3+4 in one core
Burn scares cover most of abdomen
Surgery scheduled for mid-June