Important questions to ask your **LARP/RALP/RRP** doc

If my prostate is larger than average, will this pose any problems during surgery and after as far as side effects? (For me, the prostate was large and surgeon indicated this would make incontinence a more likely side effect, however he was wrong)

If I had previous abdominal surgery, will it pose any difficulties and do you have a backup plan? (In my case, there was a potential problem and if there was difficulty he was going to abort the robot and go to the open surgery)

What alterations to the bladder will be necessary and how much bladder capacity do you expect me to loose? (In my case 1/3 bladder capacity lost.)

1 - How many surgeries have you performed?
2 - What do mthink th elearning curve is?
3 - What are your rates of success vis-a-vis typical QOL issues and cure rate?
4 - Can I contact some of your previous patients.
5 - Why do you think I'm a better candidate for surgery versus other forms of treatment including AS.
6 - Would my possibility for a cure and avoiding SEs be just as possible with other forms of treatments?
7 - What role does your staff play in my post op recovery including potential potency rehabilitation requeirements.
8 - Will you be available to me via phone and /or email after the surgery?

There are many more questions, but I'd ask the above.

I feel it is wise to ask the surgeon about his training on the DaVinci. My doctor did a fellowship, which I felt was pretty good training. I understand some surgeons have less training on the DaVinci. It's good that they did the procedure 500 times, but if they made the same mistake 500 times due to lack of training that's not so good. I would ask the same question for brachy or any other medical procedure.

Also, my incision near the navel herniated after a few months. Not a big problem, but it needed to be repaired. I'd recommend you ask how your incisions will be closed and who will be doing the closures. In my case it was not the doctor running the DaVinci.

Post Edited (RCS) : 2/6/2013 11:27:31 AM (GMT-7)

Something else I thought of because it did happen to me. When deciding on a date for surgery, ask the doctor when he is going on vacation. I wanted to do my surgery the week of July 4th. Thought fireworks going off during the operation would be appropriate. Plus it would be during my vacation week and I wouldnt miss that much work. My doctor said he couldn't because he was going on vacation the week after that, and he did not want to be out of town the week after my surgery in case something came up. So I did it the week after he got back. So, make sure your doctor is going to be around after the surgery. You do not want to deal with second stringers if you are having a problem.

Remembered another one, ask if you can have your surgery the first thing in the morning. I've read stories about the outcomes of medical procedures being better if you are the first one up in the AM.

My appointment with the Da Vinci surgeon is this coming week (Jan 21st). Here is the list I have thus far. Please help add to this list.

Questions about the doctor:

• How many procedures have you performed? (I know the answer to this one already... Over 6,000.)
  
• How many do you do per day?
  
• How many patients have you treated who are my age?
  
• Will you personally be operating the console for the entire surgery? What is the role of the other surgeons in the room during the surgery?

Questions about my preparation:

• What is the purpose of the prostate trans-rectal MRI? How soon can I get that done? (My prostate biopsy was Jan 17th.)
  
• Are there other tests that I should have to determine the exact size, location, and aggressiveness of the cancer?
  
• What can I be doing TODAY to prepare my body for the surgery and to reduce side effects? (Kegel exercises? How much is too much?)
  
• If I decided this week, when would we do the surgery?

Questions about the surgery:

• Explain the procedure… pre op, op and post op.
  
• What may be removed other than the prostate itself (nodes, etc)? How and when will you decide what to remove?
  
• Will you attempt to preserve the internal (top)/external (bottom) sphincter urethra muscles?
  
• Is the fact that my prostate is relatively small (21g) likely to make the surgery less difficult for you or less difficult for my body?
  
• How will you manipulate/remove the prostate using the robotic tools without tearing the capsule (possibly causing cancer cells to be "spilled" inside my body)?
  
• What will you do to spare the nerves around the prostate?
  
• How is bleeding controlled?
  
• How many openings will you need to make for the robotic components?
  
• Is the size of the incision above the belly button related to the size of the prostate?
• How big of an incision should I expect?
  
• How will the incision be closed? I have heard of people who have had their incision become herniated after a few months. When will the stitches/staples/etc be removed?
  
• How are the loose ends of the vas deferens closed? If there are clips applied, what material are they made of any how do you ensure that they never open?
  
• Will the surgery involve changes to my bladder capacity?

Questions about the outcome:

• What are the outcomes of your patients that are my age (cancer cure, incontinence, ED)?
  
• How about these side effects over time, i.e. quality of life 2-3, 5-10, 15+ years out?
  
• I have heard reports of penis size reductions that have occurred due to prostatectomy. Is that true, and what will be done to prevent/minimize it?
  
• What tests/monitoring will be necessary to track whether the cancer returns (in the prostate or elsewhere nearby)?
  
• How soon after the surgery will I get the pathology report?
  
• If the cancer returns, what's next?

Questions about recovery:
* How long should I expect to need a catheter?
* What role does your staff play in my post op recovery?
* What rehabilitation strategies will I use after the surgery to minimize incontinence/ED? (Daily 25mg of Viagra? Vacuum pump?)
* How soon can I return to work?
* How soon can I return to my regular daily workout regimen (aerobic/weights/cycling)?
* How soon can I return to sexual activity?
* When would you want to do the first post-surgery PSA test, and what would you expect for results?
* What is your role vs. my urologists' role in my recovery and care: 1) treating side effects from the surgery; 2) long-term monitoring for cancer recurrence;

Other:
* I'm told that if I have radiation as my primary treatment, that surgery is still an option as a salvage therapy. Do you agree?
* Will you be available to me via phone and/or email for the first week or two after the surgery?

(Oddly, it is only possible to have 4 bulleted lists in a post, and after that it stops working.)

Do you mean LARP or RALP?

Dr. Ash Tewari is a recognized robotic surgeon. That's RALP. Or robotic assisted laparoscopic prostatectomy.

Tony

Gedman - since potential ED issues is a realistic possibility, you could also ask him about that and what his practice offers in terms of rehab services. Many surgeons have in-house teams that assist you with the process, some even have formal arrangements with specialists. This could be an important issue so I'd ask.

Added two more questions to the full list above:

* When are the stitches/staples from the abdominal incision removed?
* What may be removed other than the prostate itself (nodes, etc)? How and when will you decide what to remove?

-Gedman

I had both stitches and the "super glue". The stitches were not taken out. They dissolved over time.

LARP – laproscopic robotic prostatectomy
RALP – robot-assisted laparoscopic prostatectomy (similar to LRP but with “robotic” assistance)

Can someone explain the difference to me?

RALP is basically LARP surgery with the DaVinci robot offering an interface to the surgeon which helps him control the laparoscopic arms.  I've rarely heard mention of it (LARP) being done in the past few years.

 

I changed the subject to include LARP/RALP/RRP, even if the thread is not exactly applicable to all.

-Gedman

i could be wrong, but didn't I read that that, along with getting cancer to spread through a biopsy, are myths?