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Posted 1/21/2015 9:44 PM (GMT 0)
Hi Group - Update, info needed please.

46 w/ Gleason 8 localized PC, PSA 16.9

Met w/ PC Radiation Dr. yesterday and his recommendation was surgery first, then followup w/ radiation if necessary.

So - surgery seems to be the best route and I am comfortable with my Urologist as he has done approx 1500 prostatectamy’s – however he does not perform robotic survey.

Are the differences between robotic and non-robotic surgeries so great that I should further research robotic? Thoughts?

I can handle 2 days in the hospital instead of 1, but don’t know the major differences between the outcomes of each type of surgery and any experience or info will be very helpful w/ decision making.

Thanks!
MF PC 45
Posted 1/21/2015 9:49 PM (GMT 0)
They say with open surgery there is more blood loss... But you're getting re-filled the whole time...

Since you like your URO - that would be a very good thing in my book.
Posted 1/21/2015 10:06 PM (GMT 0)
I agree with Steve and would only add that you have 1 large incision rather than 5 or 6 small ones with a RALP. Also I seem to have read somewhere that the hospital stay might be a bit longer with open,

Cheers, Doug
Posted 1/21/2015 10:08 PM (GMT 0)
There is a spirited competition between the surgeons who have adopted robotic surgery and those who continue to do open (and a few non-robotic laporoscopic guys) and, if I had to score the competition in terms of oncological outcome I would give it to the robotic guys by a whisker. But whatever difference there is on the average, it is tiny, tiny compared to the differences you find between the best, most-experienced surgeons and their less experienced or less skilled colleagues.

In general, robotic surgery has a faster recovery, requires less OR time and uses less blood. But if you have an experienced open surgeon that you like go with him.
Posted 1/21/2015 10:44 PM (GMT 0)
  Hi:

My husband had open surgery in August of 2014.  We chose the surgeon, not the methodology.   His surgeon happens to do open. 

He was in the hopsital for less than 36 hours.  His surgery was at 8:00 a.m. on a Tuesday and he went home at 11:30 a.m. on Wednesday.  He had no blood loss and they do recirculate the blood if there is blood loss.  He was in the OR for approximately 1 3/4 hours.  By the evening of the day of surgery he was already doing his second set of floor walk arounds.  By 2 weeks post op, he was taking 4 mile walks around the neighborhood and we don't live in a flat area.  He was eating normally the evening of surgery.   My husband turned 62 shortly before his surgery.

Having said that, he did have incision discomfort on and off for several weeks and it took him awhile to fully get his energy back.  He would run out of steam late in the afternoon and need a power nap.  He was released to full activity related to running, lifting weights, etc. in 4-6 weeks (I don't remember if it was 4 weeks or 6 weeks).  Whatever, he wasn't ready to lift weights at whatever point it was, although he did start doing some 2-3 mile runs.   It took him about 3 weeks to start going into the office part time and about a month until he went back full time.  I don't know if that was related to the type of surgery or how he heals.  Everyone heals at their own pace.  He was a little slower going back to work after back surgery as well.  

Robotic is way more common at this point that open, but a high end open surgeon's patient experience is basically the same as to length of stay, etc. as a robotic.

Encourage you to pick the best surgeon you can find - don't worry about their methodology.

 

Posted 1/21/2015 11:11 PM (GMT 0)
The experience and skill of your surgeon is paramount to your outcome, not the procedure type (open or robotic). However, for your consideration, let me tell you this. My surgeon told me he was originally a big time skeptic of the robotic procedure. He got so fed up with all the hype that he decided to learn the robot with the intention of de-bunking all the propaganda. However, after learning the procedure and becoming proficient, he came to the conclusion that the robotic procedure is better (in his opinion). He believes the better vision realized using the robot trumps the tactile advantage that the open procedure has.

Best of luck to you -- Tigerfan
Posted 1/22/2015 12:39 AM (GMT 0)
With robotic, I had very little to almost no pain at the incisions. Aside from the blood loss, I think that's the big difference. I know guys that have had open though, one in particular that was operated on by Dr Walsh at JH, and did open, and had little problem, even sounds like he had less issues than me.

One thing about robotic - they pump a lot of gas in you to open the field and give them room to work. And for a few days, until te gas leaves you, the pain from it more than makes up for the lack of surgery pain

At the end of the day, as has been stated, the experience and skill of the surgeon at e the most important thing
Posted 1/22/2015 12:41 AM (GMT 0)
I had open surgery done on Oct 28/14 I was in the hospital for 2 days. I was back to work on Nov 21/14, basically dry from the time the catheter came out. I have ED right now but I think it is going to be temporary. My surgeon has been doing surgeries since the mid 1980's.(I didn't get a total but was told he has done thousands) Robot wasn't offered to me in my area. My experience has been very successful with open. Hope this helps
Posted 1/22/2015 12:42 AM (GMT 0)
I agree that skill and experience are number 1 priority. I had open surgery at my surgeon's recommendation although my surgeon did both. The incision is long, from navel to pubis but who cares about the scar.. It was very painful when coughing for first 24 hours. I was in hospital two nights after flying to Johns Hopkins from South Carolona. I played 17 holes of golf after three weeks. I did not need any blood and had no complications. cath was out after 13 days, by local Urologist. I can't comment on open vs. DaVinci but I've read that DaVinci results in fewer side effects like ED and incontinence. I have total ED after 16 months but I've also had HT and SRT so not sure what is the cause.
My only concern is that I don't have reoccurrence. So far so good!
Bob
Posted 1/22/2015 3:45 AM (GMT 0)
I had open surgery because it was what the surgeon preferred. It probably does take a few more days to recover, but it isn't a big deal. They say to pick the surgeon, not the technique. I think that's right.

When I was weighing my decision, I talked to a medical oncologist. He said that in a year I wouldn't care that it took a few more days to recover. That clinched it for me. He was right.

Good luck with your procedure.
Posted 1/22/2015 4:26 AM (GMT 0)
I had open, because the urologic surgeon did not do robotic, which was less widely available at that time anyway. All other things being equal (which they never are), robotic trumps open because of the shorter recovery time.
Posted 1/22/2015 9:48 AM (GMT 0)
I guess by the answers so far it's not the same situation than in the US, but here in Spain the gold standard when concerning prostate cancer surgery is LPR, e.g. non-robotic laparoscopy. In fact the center performing by far the highest volume of surgical procedures is exclusively LPR. According the them the robot only helps when very early in each particular surgeon learning curve. But of course there is also the matter of da Vinci not being covered by the Health system or private insurance :-)

Just a heads up in case your urologist is one of the seemingly few that do LPR in the US.
Posted 1/22/2015 7:33 PM (GMT 0)
I appreciate everyones comments and info- thanks -

Aside from being cured of PC, I would like to choose the surgery with the best possible outcome in the ED and Incontinence departments, so i am on the fence about which to choose.

Does robotic offer better erectile function than open surgery does? I've a good, good surgeon but don't know if robotic offers better chance to NOT suffer from ED.

Anybody have specific info or experience?
Posted 1/22/2015 9:02 PM (GMT 0)
The only thing that matters once you have made the decision to have surgery is the skill sets of the surgeon. How many has he done and what are the outcomes? I was all set to go robotic... cutting edge, more magnification, less blood, quicker recovery etc. vs the traditional open surgery. However when asked how many he had performed I was told over two hundred which is good. However the open surgeon had done thousands. I opted for the latter. When I am laid out on the table I want the Dr with the most experience, has seen virtually everything, does not get shaken when BP drops, or there is more blood, etc. Don't give a rip about bedside manner or whether you "like" the guy. It's not like you are going to be best friends after your surgery. Odds are you will see him a few times after your surgery and never again.
Posted 1/22/2015 9:13 PM (GMT 0)
There are so many variables involved with ED side effects, that it can't really be determined by a single open vs. robotic surgery consideration. I worked with a couple of urologists regarding ED issues (I had nerves spared on both sides with an open surgery), and they both emphasized that it is an issue that varies with each man. Part of my problem was that I already had ED and was taking Cialis prior to surgery. Secondly, I can't use trimix injections due to the pain (about 20% of men are in this group). And bimix is not as effective.
Posted 1/22/2015 9:47 PM (GMT 0)
MFPC45 -- Again it's the skill of the surgeon that matters most. Be sure to ask your uro about penile rehabilitation after your surgery. (Mine started me on penile rehab before surgery). You need to keep your erectile tissue healthy while you wait for your nerves to heal.

-- Tigerfan
Posted 1/23/2015 12:45 AM (GMT 0)
The surgeon I've chosen did open RP's for years before he learned robotic. This seems like an advantage in that he's seen pretty much anything. I agree with the other comments, in that it does seem that the two major factors in success in the OR are the skill and experience of the surgeon, and the attitude and trust level of the patient.
Posted 1/23/2015 2:55 AM (GMT 0)
I did open. I was in the hospital about 20 hours longer than you. I also was on the table 3 hours longer than you. It was a teaching hospital the students disected 27 lymph nodes, all negative. Nice fire wall I thought. Yeh yeh, I know about the other pathways, Walked 2miles back to our condo{rental} when released. Im a traditionalist in someways and all other things being equal, prefer the feel of a small handed surgeon as he checks the erectile nerves for cancer, rather than titanium or whatever they are made of. So I would say, very arguably, open is better. Oh one 4" scar barely visible close to 5 1/2 years later. the only thing I ever hear better about da vinci is recovery time. blood loss is moot these days ,lessen you are leary of someones else blood. The lymph node removal created 2 ping pong ball lymphoceles. { google} After all that. Its the surgeon!!!!!
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