Date with DaVinci

When I was diagnosed with PCa an inguinal hernia was confirmed. At that time it was small and not causing any issues so we have practiced Active Surveillance for more than seven years. A few months ago it started presenting many of the classic symptoms including pain and discomfort, but not yet bulging. So, recently an in depth assessment was made including ultrasound imaging and it is time for surgical repair. It won't get better, I won't be in a better position for surgery ten years from now, and there are not any non-surgical methods of repair. So under the knife I go.

This type of surgery is one of the most common with about one million a year in the US. I was given three choices; open, laparoscopic and robot assisted laparoscopic using the da Vinci system. The surgical group I am using does all three. Interestingly to me, though the two minimally invasive methods have proved to be better than open regarding shortened recovery times, less pain, fewer complications and better long term results; most the surgeries continue to be open.

I have read several studies, reports, assessments and papers and they show the learning curve for laparoscopic is pretty long as the visual is 2 dimensional, so a lot of surgeons feel better with the open method. Conversely, the robotic learning curve is very short and the visuals and tactile aspects are similar to open and far superior to laparoscopic. Thus surgeons become competent quickly and once competent with laparoscopic they become immediately competent with the robotic. The assessments show that laparoscopic and robot assisted are similar for effectiveness and other advantages over open and that the mesh placement is much better for robotic. Recovery time, pain, complications, recurrence are all comparable for both. However, robotic costs a little more and the procedure takes longer by about an hour.

So I asked the surgeon which he prefers. He basically said no to open and does only laparoscopic and robotic. If a person wants open, another surgeon in the group that only does open is engaged. He then said his preference is robotic. He said he sees so much better with the 3D high definition optics, the arms have an articulated wrist with greater motion than the human wrist, the program is tactile so he feels in the controls very similar to what he feels in an open setting and he can check the right side and repair, if needed, during the surgery without re-positioning equipment or making any additional incisions. about two-third of men end up having both sides done. His credentials are very good, he is young and sufficiently experienced and took time with his explanation and discussion and all around a nice engaging person. The kicker was when I called my urologist for his advice. He said "get it done. Use this doctor, he did my hernia two years ago, he is great".

So next Thursday I meet daVinci. The surgeon does most of his hernia procedures on Thursdays to get patients back to work the following Monday. I know some on the board have had hernia surgery. I would certainly appreciate any advice or information that will help this go very well.

I had a right inguinal hernia repair nearly 40 years ago, so I don't know how valuable anything I might have to say would be in today's environment. It was my first surgery other than childhood surgery... mine was pretty bad and back then it meant nearly a week in the hospital.

Many of the issues I recall were pretty much what I had following the prostatectomy two years ago... constipation, difficulty getting in and out of bed, unable to bend over to put on slippers etc. It's still abdominal surgery.

As you had primary radiation (if I'm reading your sig correctly) I don't know if you've had previous abdominal surgeries. Following the hernia repair I had a bowel resection just three months later, and it really messed up my head. Prepared me for future battles I suppose. Just had surgery #14 a couple weeks ago.

Anyway, you've been living with this condition for so long that you're likely beyond any shock potential. Given how surgery has advanced in the past four decades I'm sure you'll do fine. Remember you will have weight restrictions for about a month or so. Turns out that ten pounds isn't much. Take your time and recover gradually and properly.

And good luck to you in the coming month or so!

Well I had a left inguinal hernia repair 2 years ago. Unfortunately, because it was a bit large, the general surgeon did an open repair. The procedure was about 45 minutes. The scar was about 2" and I left the hospital a few hours later. I, too, had it on a Thursday. I took Friday off and went back to my desk job on the following Monday. No complaints.
I did have a mitral valve repair done assisted by the daVinci robotic system 9 years ago. Start to finish including setup was about 3-5 hours. My recollection is that the surgery itself was maybe 1-1.5 hours. I think I was on the heart-lung bypass machine about 30-45 minutes. I had five (0.25-0.50") incisions. I was out of the hospital in 3 days. Worked out great.

Jack, good luck, I’m sure it will go smoothly

Good Luck Jack......David

Mine was open with nerve block. Home right away after. Used bag of frozen peas on wound. On bicycle (on trainer) within 5 hours of procedure. Tough getting leg over top bar but felt good to spin. My experience is working up pulse and respiration expedites surgical & injury healing.

Good luck with it - no complications & quick recovery

Wilderness

Jack,
Trust it went well. If you have time, please give us a report.

I had the surgery on the 24th of May. All very uneventful. I was in surgery for about 90 minutes. Doc told my wife it was textbook all the way.

Recovery has been uneventful with very little pain. I took half doses of the Narco for two days primarily to help relax and sleep. For a few days after that I took Advil on a regular schedule. . I had one area where the most work was done getting to the hernia that would cause some discomfort when laying on my side, so I was limited to sleeping on my back for about 10 days. The initial meds did leave me constipated for a few days and I overcame that with a few doses of Mirilax.

My surgeon uses a bit different technique with the DaVinci than the traditional laparoscopic method. He makes the three incisions about three inches above the navel in a line across the upper abdomen. These are for the camera and robotic arms. This lets him use less co2 to create the cavity to maneuver the tools. He also opens a flap of tissue that lets him have better access to the hernia to insert the surgical mesh better getting it smoother before attaching it. He contends that the most significant negative side effects are when the mesh isn’t perfectly smooth or has a wrinkle or fold. Thus, he attempts to get it smooth and has better results with this technique. He was also able to check the right side and thankfully found no hernia. From entry to egress I was in the hospital less than five hours.

At the two week mark I had the post-op exam which was very thorough. He recorded every detail of my pain med use both prescription and non-prescription. He manipulated various areas of my abdomen and gave me a very thorough hernia exam on both side. He was pleased and said the repair was complete. He and his partners chart the experience from each method the practice uses and continues to find that most patients are using less pain meds when the surgery is robotic. When I was leaving the hospital, the hernia repair was very evident and I have not had any of the discomfort or sharp pains I was experiencing before the repair....like night and day. So very successful.

I am just at the point of being 100%. I followed directions well as to limiting some physical activity particularly lifting. I got back on the treadmill immediately and extended the walks I already do and I am sure this helped the recovery. Last week I went kayaking and all was fine, though it was the type of activity that was not allowed in the first 6 weeks. No problem.

We discussed the different techniques and he said the major learning curve for the DaVinci from the open is that the surgery is essentially inside out with many things being reversed. He found in training that understanding this and adjusting hand eye coordination was very easy for him compared to many of his colleagues. He is now doing three or four robotic procedures every Thursday. He expects in the near future he will have two days a week on the DaVinci. I was the first of the three on my day. He also gets to use the DaVinci a couple of times a week for practice. In his surgical practice the partners are doing more to specialize their techniques with some doing most all the open procedures and he is moving toward most all his procedures using the DaVinci.

Thanks to everyone sharing their experiences and advice. All very much appreciated.

Jack, glad you got this done and had a 100% recovery. Now you can just enjoy your grandchildren 😄💕

Glad to hear of the post-op success. This post is interesting to me as I was told from one of my tests that I have a small bilateral fat containing Inguinal hernia. lately it has been causing me annoying pain on my left side, but wonder how urgent to repair right now as I will be making PC choice in the coming weeks. Ed

logoslidat said...
I had left side inquinal...ez breezy...this was 15 months ago...no problems...don't expect any...why expect the worse...its better to expect the best...or am I a Pollyanna??

Good point. got bigger fish to fry right now.. Ed