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Da Vinci - Experienced surgeons in Texas? Also top 3-4 experts in USA?

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Posted 8/18/2007 10:40 PM (GMT 0)
I have been recently diagnosed with prostate cancer. I am 55 yrs. old. My PSA is 3.9 w/ .5 Free PSA and 13% Free PSA. My biospsy results indicated 3 of 12 samples were cancerous with a gleason score of 6. I have had no prior surgery. I am interested in the Da Vinci Robotic surgery. I live in the Dallas-Fort Worth area and have been unable to locate a surgeon who has completed very many of these surgeries. I have read about Dr. Randy Fagin in Austin,Tx; Dr. Justin Lee in Arlington, Tx. and Dr. Kevin Slawin in Houston ,Tx. Does any one know anything about these guys? Also , who are considered to be the best 3-4 experts in the whole country? I am willing to travel out of Dallas for the surgery if necessary. Thanks in advance for your help. Thanks, Laswell Edited to override (***) Dr. Fagin's name :) Post Edited By Moderator (bluebird) : 8/23/2007 2:04:22 PM (GMT-6)
Posted 8/18/2007 11:26 PM (GMT 0)
Hi laswell, You may wish to try the following: (1) Go here: http://www.davincisurgery.com/ (2) Then click on the "Find a da Vinci Surgeon" link at the right top of the page. (3) Put in you zip and the site should give you a list of surgeons near you. My surgeon came up when I put in my zip code. Next, you could do a "google" search on the doctor's name with the city, state she/he is in.  This may help you find more information about the doctor, including a possible office or practice web site from which more information may be obtained. Hope that helps. Idaho
Posted 8/19/2007 10:37 AM (GMT 0)

Laswell,

There are many good da Vinci prostatectomy surgeons in Texas.
A cautionary tale: The general adoption of the da Vinci equipment is relatively recent and mathmatically, many surgeons seemed to have "rushed" to the magic number that many patient/customers associate with expertise. 

One surgeon I know of is doing 5 surgeries a day several times a week.  His pathologist told that on occasion the surgeon has "nicked" the prostrate in removal and sutured it closed....    ?!?
Das ist nicht so gut.  Es tut mir furchtbar leid....
This could give new meaning to the term "Free PSA..."

The best and most experienced surgeons can take five hours to perform a radical prostatectomy - da Vinci or otherwise.  There aren't that many hours in a day.  ("...nurse, close please.  Next....")  If a surgeon claims a thousand da Vinci procedures and has only had access to the machine for a year, I would be concerned with more than just her/his experience level.

If travel is no issue (include post-surgical visits in your calculations), then UCLA, Johns Hopkins, or Boston General would leap out to me. 
A very good surgical team can be found in Austin with Dr. Koushik Shaw & Dr. Satish Karnik. 
This team (with Austin Diagnostic Clinic at St. David's North Austin Medical Clinic) has been using the da Vinci machine much longer than most medical centers - but only do two surgeries a day - two or three days a week.  I used this team and got my second opinion from Dr. Maten at M.D. Anderson in Houston.  Dr. Maten is most excellently skilled & experienced.  Like most medical facilities, M.D. Anderson got their da Vinci machine over a year after Shaw & Karnik were using it in Austin. (If googling Shaw or Karnik, both came to Austin from Tulane in New Orleans after Katrina.)  I personally recommend either of these teams in Texas.

I'm certain Baylor Medical in Dallas can supply a good team.  As Dr. Maten's Physician's Assistant explained to me, experience in non-robotic laperascopy and open procedures should also be taken into consideration.  Non-robotic laperascopy is much more difficult than the da Vinci procedure - and yet similar.  Experience with the open procedure is actually becoming the rarity now.  New surgeons flock to scheduled open procedures to view the "lay of the land" that is less and less frequently exposed.

Welcome to the Healingwell Forum!

CCedar
ICTHUS!

Posted 8/19/2007 3:07 PM (GMT 0)
Hi, Laswell. Last August, we traveled to Austin for robotic surgery with Dr. F.A.G.I.N. At that time, Dallas and Houston surgeons were just getting on the bandwagon with da Vinci, while our doc had done more than 300 at the time (plus a few hundred laps prior). His background and training are remarkable. We literally could not even find a way to get in touch with the Arlington doc (very odd). Through a phone call, we were sent to a web site to make an appointment and once there, could find no info. I'm sure that has chanced since. Then, we located a robot in Tyler, but the staff couldn't exactly pinpoint how many surgeries the doc had done at that time. It was "maybe" more than 50, but "maybe" even as many as 100. Not enough for us.

Our Austin experience was outstanding, as others here who have also gone to Dr. F. will also attest. What impressed us greatly, too, is that he is very proactive with post-surgical issues and his entire staff is very gracious and helpful as well.

Dr. F. generally schedules a full day to handle 3 surgeries. He takes whatever time is needed to do it and ours was a bit over the 2.5 hour mark. We asked to be first on a Wed. and everything went off on time.

It's not an easy decision by any means. Please feel free to ask any questions - obviously we're biased toward Dr. F., as everyone else here feels the same way about their own surgeons.
Posted 8/19/2007 4:54 PM (GMT 0)

As others have stated, I am not impressed when a surgeon brags that he has done thousands of DaVinci surgerys in a relatively short period of time.  That tells me he uses an assembly line approach to surgery.  It also tells me he is "tooting his own horn" to much.

In a recent discussion, I found that my surgeon will only perform four DaVinci surgerys per week.  His PA said they plan to increase that to five due to increased demand. My surgery took four hours and was very successful.  The doctor took time to sit down with my wife and daughter to reassure them after surgery.

My surgeon is the chief of robotic surgery at the local medical center. He has done hundreds of Davinci surgerys, one at a time. He does not have a web site nor has he written a book.  He just goes out and does good medicine. No self promotion necessary.

That is the kind of doctor you should be looking for.

Posted 8/19/2007 7:21 PM (GMT 0)
Hi LaswellVIEW IMAGE

     I have been going through the same process as you. As others have already posted, you have some excellent DaVinci surgeons in your area. Outside of the Texas area, there are many more excellent DaVinci surgeons: Menon (Detroit), Patel (Ohio State), Tewari (NY), Su (John Hopkins), Lee (Penn) just to mention a few - all of whom have done at least 1000. I have met with three of these surgeons (Patel, Tewari and Lee) and they are all very good. The numbers that are quoted by the surgeons as to number of procedures may include procedures they "participated" in as opposed to actually operating the Robot during the surgery. You should ask if they actually did surgery in each instance. Also, you should inquire as to the "team" they use during DaVinci surgery and how long they have been working with the doctor - to me that is important since they are involved in the procedure as well.  Once you have met with surgeons, you will have to determine from the numbers being quoted by the doctors and their websites, etc. how much is hype. In the end as everyone states you must be comfortable and confident in your choice.  

Posted 8/19/2007 8:22 PM (GMT 0)

Laswell - I also live in the DFW area and chose to go to Dr. F.a.g.i.n in Austin for my surgery completed last Monday. Contrary to what some have said here about volume of procedures done, many resources I researched said proficiency with ANY procedure - open, robotic, or others - comes with volume. Another reason I chose Dr. F. is that, in the unlikely event something were to happen necessitating aborting the DaVinci procedure, Dr. F's backup is straight laparoscopic.  Other DaVinci surgeons I spoke with indicated their backup procedure would be to revert to open surgery. My wife and I found Dr. F. to be very caring - even called us at home on a Sun. afternoon and spent 30 minutes answering our questions before we ever travelled to Austin.  He will also answer questions by email, usually within 24 hrs.

Here is a day-by-day review of my DaVinci surgery and the first 5 days post-op:

Prostatectomy completed by Dr. Randy F.a.g.i.n, Austin TX on Mon. 8/13 -
I was brought into the OR at about 12N and returned to my room at
245P after spending approx. 1 hr. or so in recovery - surgery 1h 45 m. Got out of bed
around 7P for first walk around the hospital floor - maybe 5-7
minutes. Completed another walk of 7-10 minutes before going to
sleep for the night. During hospital stay and since, have taken no
narcotics for pain - only Motrin twice a day.

1 day post-op: did a couple more floor walks between breakfast and
lunch, received catheter care instructions and discharged early
afternoon. Returned to local hotel. Walked up set of stairs to
second-floor room at hotel. Took long nap. Completed a 10 minute
walk around hotel floor after in room dinner with family - all meals
consist of liquid and/or soft foods, e.g. mac and cheese.

2 days post-op: light breakfast, 10 minute walk on hotel floor,
sitting and reading, another 10 minute walk including down/up stairs
at both ends of hotel floor, soft lunch, checked out of hotel and
rode to airport for flight home to Dallas - 45 min. flight better
option than 4 hr. car ride. Felt really good until arrival home, then
had case of the "blahs" the rest of the day. Daughter-in-law brought
tasty potatoe soup for dinner. Good night's sleep in own bed.

3 days post-op: light meals, took shower, created walking path
throughout our house and completed 3 15-min. walks throughout the day
and evening, otherwise sitting and reading. Still feel bloated from
gas used during surgery which has not dissipated. Have been able to
pass gas but no bowel movement - took dose of Milk of Magnesia before
bed (issue resolved at 2AM!).

4 days post-op: friend from church picked me up at 1130A to go to
church rec center for 20 min. walk, then met another church friend
for lunch at restaurant - ate baked potatoe, small bowl of clam
chowder, and piece of gingerbread with whipped cream (my favorite
dessert there!). Church choir members brought dinner - fresh fruit,
roast chicken, potatoes and carrots, fresh rolls, plus ice cream for
dessert. Watched baseball on TV most of the day and forgot to walk
around the house - mistake - too much sitting led to sore perineum by
bedtime, but have been using donut pillow whenever sitting.

5 days post-op: light breakfast, 20 minute walk around the house,
reading and TV (Little League Baseball World Series). Another choir
provided meal for lunch - chicken salad on buttery croissants with a
few potatoe chips. Friend picked me up at 120P to gather at a
restaurant with a few other former IBMers for quarterly get-together -
had to pass on the pizza. Wife picked me up after an hour to go to
church for another 20 minute walk - actually did 25. Then came home
for an hour nap.

At this point, I feel great - minimal pain/discomfort, have survived
2 sneezes, appetite is improving as well as variety of food I am able
to eat. I am still to avoid all gas-producing foods until cather
comes out - scheduled for next Tues (surgery + 8 days). Anticipate
returning to work at least half-time the next Monday (surgery + 14
days).

I hope this somewhat blow-by-blow dialogue is helpful for others
considering the DaVinci procedure for resolution of your prostate
cancer. Post inquiries if any questions arise or you would like other
info I may have overlooked in the above.

 

(Laswell - if you would like to talk directly, send me your phone number to my email at [email protected])

Posted 8/20/2007 1:01 PM (GMT 0)

Laswell,

There are a lot of good surgeons around the country and many with several hundreds of procedures of experience.  There are those that market themselves and others that you hear their name frequently.  In my case I wanted to go to a univerisity based medical center.  One of the key reasons was that I felt that a surgeon at one of these facilities would be more focused upon the outcome of the surgery as they track their results for research and the teaching aspects versus making money.  I chose Vanderbilt University because the head of the urology department there was very experienced and it just happened to be within a couple of hours of where I live.  Like you I was willing to travel anywhere for the surgery.  My surgeon at Vanderbilt, Dr. Joseph Smith, had done over 3,000 open types when he started doing the Da Vinci in 2004.  He told me that the reason that he started doing the Da Vinci was because he was skeptical that the results with the robot would be better then the open so he wanted to prove that it was not.  At the time of my surgery he had done close to 900 Da Vincis and was doing about 9 a week in three days.  While they have not published anything yet he told me that the data collected over the number of Da Vincis that he has done indicates that the incontinence and impotence side effects are statistically better with the Da Vinci.  When I asked him why Vanderbilt does not come up as commonly mentioned in regards to Da Vincis he said that they have no reason to market themselves as their demand is very high and that he has done surgeries on men from all around the globe.  My wait time for my surgery was three months.  Everytime I have been to see him there has been a Chinese doctor with him doing a fellowship study. 

Hope this helps some.

Tamu

Posted 8/29/2008 3:26 AM (GMT 0)
even though these are old postings...thjey are extremely valuable...
I sent an email to Dr Fagin.....total stranger to him...

within 12 hours he emailed me back and asked for the best number to phone me...

amazing.

thanks for the info

Mbshine
Posted 8/29/2008 12:50 PM (GMT 0)
My Doc was Fagin in Austin and I could not have had better care - FYI. Blessings to you! RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04
Posted 8/29/2008 1:04 PM (GMT 0)
Mbshine thats fantastic to hear. Glad that you are continueing with your search for the best. I have heard of Dr. Fagin many times, however I elected to go with a surgeon at the Dallas Baylor Medical Center which is one of the leading hospitals in the country as well. I am just happy to hear that you continue to move forward.

Stand tall and proud
Posted 8/29/2008 1:14 PM (GMT 0)
I would highly recommend Dr. Mcihael Esposito in NJ. He and his partner Dr Lateri have over 2000 performed together. They acutally wrote a book on the surgery for other doctors. They not only do the surgery they teach other doctors not in their practice, including ones down at John Hopkins. They also work with the maker of the da vinci rebot to make modficiactions based on their experience. http://www.roboticurology.com/

Good luck, LIVESTRONG!!
Posted 9/1/2008 6:09 PM (GMT 0)
I recommend Dr. Ash Tewari in NYC.  He does not do them assembly line and does extra steps to help attain continence.  He is highly recommended by Dr. Stephen Strum and others.

Posted 9/1/2008 9:59 PM (GMT 0)
hello there i would like to shed some of my own experience if you would like to comsider it,olease go to [email protected]  and speak with john chandler as he has donre a study of the best docs in the entire country as well as the world over ,any one can say my doc was good but there are several factors that determine it, my doc is on that list and was compared to the three top docs in the country .what your looking for are consistant outcomes ,alot of docs cherry pic their patients for good outcome results , my doc was doctor mark kawachi at the city of hope  in duarte ca. he does NO advertising and is only word of mouth , i HIGHLY recomend him you will notice that some people say ......well i couldnt get a straight answer out of him as far as out come ... if there is a doc tha t can give you one run like hell brother hes a fake,this is not an exact science so beware. 95% of his out comes are better than average the other 5% i can only guess were due to patient responsibility i.e. obesity ect. this all affects your out come so for whatever its worth  take it or leave it ive had exceptional outcomes as well as many patients of his whom ive RANDOMLY contacated good luck this isnt  gospel  only my opinion  ,google mark kawachi and see whatcha get  he authored many papers on the subject and it is his passion  he is the doc that pioneered the first laproscopic surgery on the west coast a true craftsman  in his trade .....dirt


Posted 9/2/2008 12:42 PM (GMT 0)
Hi, MBshine - good luck. We continue to be impressed with Dr. F. even 2 years post surgery. Although we have returned to local docs for psa tests, Dr. F. still sends followup postcards. If we were to run into any complications (a rising PSA), we'd be heading right back to Austin. Everyone here loves their particular surgeons - and that's just the way it should be. We'll be eager to see your progress.
Posted 9/10/2008 9:12 AM (GMT 0)

re DR RANDY FAGIN

Sunday I was on I-40 from ABQ heading to Vegas and Dr Fagin with whom I have never spoken or met, called me on my cell phone for 15 minutes.

He was gracious and candid. He has operated on obese patience but said there is the heightened chance of complications and in one case the whole procedure had to be aborted. The problem is extra fat and thick skin in the body cavity which does not "inflate" enough when the Co2 or whatever is pumped in by the anaesthesiologist and does not leave enough space for the robotic arms....

He was not only in favor of bariatric surgery but said the early prostate cancer diagnosis could actually be a blessing towards longterm better health with an initial jump start to significant weight loss.

Ispoke to my primary care physician in Taos and he basically said there is no one with proper experience in NM but he has successfully referred patients to Colorado Springs and I will meet with him next week. Dr Fagin said I should keep in touch with him with my progress and he would be glad to meet with me down the road.

For the benefit of our readers here, Dr Fagin agreed with my own urologist who said that I basically had gone to the man who invented the procedure, Dr. Guillonneau and his diagnosis and advice was not only solid but usually not contradicted by people who one way or another are his disciples--which means just about anyone who is exdperienced and successful with the DaVinci...;

mbshine

Posted 9/11/2008 1:23 AM (GMT 0)
Dr. Justin Lee (in Arlington at USMD ) did my Davinci 19 months ago.
Great surgeon!
Posted 9/13/2016 12:08 AM (GMT 0)
Hi Laswell
Newly diagnosed and have follow up with Dr Justin Lee tomorrow. Wonder who you ended up going with?
Posted 9/13/2016 4:32 AM (GMT 0)
Paul B

That was an eternity ago in this environment. Why would you even care what happened nearly a decade ago? There are many world class surgeons in Houston, Dallas and maybe Austin.

He went with Dr. Fagin in Austin. His post here eight days after surgery stated that his post surgery path report positive margins, EPE, and T3a. That was the next to last post from Laswell.

Post Edited (Octorobo) : 9/12/2016 11:06:37 PM (GMT-6)

Posted 9/23/2016 5:55 AM (GMT 0)
Paul B

I'm currently trying to determine what treatment to pursue & live in Austin.

If I do end up going with a RP, I was thinking of MD anderson, but I'm also keeping my options open for a Austin surgeon.

I'm meeting with Dr Shaw tomorrow to have him look at my biopsy results.

I agree volume is important... and I think Dr Fagin might be well versed by now... I really liked his live procedure recorded here: /www.youtube.com/watch?v=g4Kru2tOR3o

Really shows how Fagin knows "little tricks"

Zzarth
Posted 1/9/2017 6:55 PM (GMT 0)
Thanks for posting Zzarth. I live in Austin, and on 12/02/16 was officially diagnosed with PC as well (by Dr. Shaw). At age 60 years with a recent PSA = 4.4 (not too bad), Gleasons in 3 of 12 at (3+4, 3+4, 4+3), N0, no PNI detected, capsule appears intact, and a small 26 cc gland (probably a good factor). Therefore, I'm very interested to know which surgeon you chose to perform your RALRP? What was your experience? What have been your results?
Posted 1/9/2017 7:08 PM (GMT 0)
Dr. Mani Menon (Ford Hospital, Detroit) did mine. When I researched surgeons, he was at the top.

Mel
Posted 1/10/2017 12:17 AM (GMT 0)
Sorry to hear you've been diagnosed with PC. Well I was diagnosed at the end of last year and had my surgery on Nov 21st. I can say that my surgeon was great he's with USMD in Arlington (DFW) which specializes in Prostate Cancer Surgery. My Dr, Dr Waguespack was great, his office is actually in Las Colinas. He is compassionate and passionate about his profession. He shared that he know's he'll be getting PC at some point, as he has a family history, and treats patients as he would want to be treated.

He actually recommended doing a MRI which was not typically called for to make sure he could evaluate any issues. In my case this was helpful.
Posted 1/10/2017 1:10 AM (GMT 0)
Guys, This is a thread from 2007 !!!
Posted 1/10/2017 1:25 AM (GMT 0)
ASAdvocate,

Thanks, but your point with regard to age of this thread not valid nor productive. Note that Zzarth's post to which I directly replied was made on 9/22/2016, far more recent than 2007.
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