Open (prepubic) vs. Laparoscopic (robotic) Prostatectomy

I'm Tom from Kingsport.  Kat suggested I might start a new thread with my question about which surgery to opt for.  My signature has the facts about my situation.  I've been obsessing about it for a couple weeks.  Staying in town for the open surgery or traveling 5 hours (to Vanderbilit in Nashville) for the laparoscopic (robotic).  Anybody else wrestle with this kind of decision?  The research claims of the laparoscopic centers -- for the most part -- make it sound like the much-preferred surgery (regarding blood loss, pain, recovery time, & fewer urinary problems later), but other sources make it sound less clear.  I'm a bit befuddled and trying to get unstuck in my decision process. My local surgeon who does the open kind is very experienced & has a good reputation, but Vanderbilt has an outstanding rep also with the robotic-laparoscopic.  Thanks in advance for any thoughts/suggestions.  Tom

I opted for the open RRP.  The reason I did was because my surgeon and hospital were less than two miles away.  In Oklahoma City there are only two Dr.s that do the DiVinci operation.  There is only one machine in the city also.  The wait time to get the surgery is about 3 months.  My Dr. made me fee very good about the open RRP.  He is assisted by one of the other Dr.'s in the practice. I have never heard if the Dr's that do the DiVinci have a assistant or not? My Dr's do so many of them they have very little blood loss.  As far as vision and magnification he said all of the structures with this surgery are large enough for im to see without the need of extra magnificaton.  Not sure how long th DiVinci operation takes but I was in and out in two hours.  I did have a 6 day stay in the hospital due to a clotting problem I had with the cathiter post op.  I have had bleeding and clotting issues with previous operations.  I don't think it had anything to do with the quality of my Dr.'s work.  It was just one of those things that happen some times.  Due to the clotting, I had to keep my cathiter for three weeks for everything to heal.  it has been two weeks since it was removed and I have no more gushing.  Only using 5 light duty pads a day.  Walking in the key to getting control of bladder back.  Was given 25mg Viagra to take daily.  Have been having some growth and firming but no full erection yet.  The incision never gave me any trouble.  Very little pain, healed up quickly

Overall, I am very pleased with my decision to go with my Dr. and the open RRP.  Being so close to the hospital and Dr. was much easier on the family.

Which ever route you take it will be the right one for you.

Good Luck

Tom:

I agree with Aus.  Selecting an "expert" with significant experience and exemplar credentials is the most important factor.  After my research and discussion with knowledgable professionals, I realized you go for the best out there, no matter what procedure they specialize.  If your insurance is part of a national network, don't worry about travel if you have the means to do so.  I live in Louisiana and selected a surgeon at Johns-Hopkins in Baltimore.  My insurance provided coverage at Hopkins just like it would have done if I had stayed at home.  No difference.  I did have to fly to Baltimore (not too expensive), and I booked a hotel room downtown Baltimore through Priceline (cheap) for the night before surgery and the night after discharge.  I flew back to New Orleans 72 hours after surgery (it was not difficult, really).  My "expert" specialized in the open procedure.   Here's what happened:  in hospital 48 hours; no transfusion (little blood loss for me); return to work 12 days post surgery (office job) for 2-3 hours per day the first week, 1/2 days the second, 3/4 the third, and full time the fourth; running five miles in 47 minutes seven weeks post surgery;  pad free after four weeks post catheter which I had for 10 days (I used only 28 pads the entire time); and, best of all, <0.1 PSA three months post surgery.  I never had a reason for a return visit to the surgeon. 

The point I'm making here is that the surgeon, not the procedure, should be your #1 criteria.  I think my result establishes there is little to no difference between the best open surgeon and the best robotic/lap surgeon.  If you have the means to travel to have the best surgeon, don't hesitate.  The better chance for an  excellent long-term result with an "expert" far outweighs the inconvenience/cost of travel.

That's my two cents worth.  Good luck.

Thanks to all of you -- Tamu, SJC, aus, kw, and josal & any others sending wise decision-making vibes. Very informative and supportive! I plan to make the decision by Monday, 11/27. ~ Tom

Hi Tom *Kingsport,   Sending a warm welcome to you and your loved ones….   I personally think if someone took the time to really do a graph on open (RRP) or Lap(robotic)…. Results (blood loss, pain, recovery time, and fewer urinary problems) ~ they would be so similar.     For anyone to say one is better than the other is in my opinion… not something I care to look at.    Each doctor will tell you their method is best!!! And rightfully so ~ but to say one surgery is better than the other…..    If you want open… then find the best surgeon who does RRP, if you want Lap… then find the best surgeon who does Robotics.   Your decision ~ is your decision ~ and it will be the right decision for you.   Buddy & I chose the open (RRP)   as you’ll see in “Our Journey”…. It was the right decision for us!!     Our thoughts and prayers will be with you as you take the next step.   Please stay with us as you traverse the stepping-stones to be cancer free.   This journey is best traveled with friends…..   In New Friendship ~ Lee & Buddy   Sharing ~ Our Personal Threads with new members:   updated   11-17 If you or your loved ones ~   pull “1” thing from our journey that helps you on your journey…… it will truly make our hearts happy!!!   Our Journey ~ Sharing is Caring, A Special Note for Loved Ones (Wives, Partners, & Caregivers) , Give Yourself a Second Opinion, and Murphy ~ Our Special Helper. To quickest way to find them   is to change the way you look for Threads…   I have mine set at Last Comment.   If you go in and change it to Started By and look for Bluebird (pages 4 & 5 as of Nov-10 ‘06) …. You will find them a lot easier!  

Hi Tom,

There's not a lot i can add to what these folks have said....they all know their stuff, and it is a tough decision for you. The idea of laparoscopic appealed to me because of the recovery time from the incision alone. I'm not sure if Chattanooga is closer to you than Nashville, but if you decide on the DaVinci, you might want to check out Dr. Patrick Foley. Parkridge Hospital's nurses leave a lot to be desired, but i was only there one night. Recovery time has been awesome....i'm almost fully recovered 11 days afterward. I'm taking it slow and walking every day. I have 5 small incisions that are a nonfactor at this point. Some soreness where the drainage tube was, and soreness from the catheter, but i'm losing that fast. We wish you the best in your decision.

Blessings,

Dennis and Sara

My husband, Billy, has an appointment at John Hopkins for a second opinion. When you have a consultation is it with a group of doctors or just one. Is there one doctor that anyone on this board has been to and really liked? Everything I have read and people we have talked with emphasizes how important the surgeon is but also that he needs to listen to you and you feel comfortable with him. Any suggestions?

Hi Tom ~   Just checking in on you!     It’s been over a month since we’ve heard from you! Touch base when you have a few minutes.   We would like to travel with you on your journey.        Buddy and I hope you’ve had a chance to visit our Thread: “Our Journey” We chose Radical Retropubic Prostatectomy   Excerpt from “Our Journey”… (C) We had already made our decision before the Consultation Radical Retropubic Prostatectomy…..Lift the Hood …We wanted Dr. Staley to visually see and feel the tissue and take out all surrounding tissue that may be hiding… cancer cells.       Excerpt from “Our Journey”… KNOWLEDGE IS POWER... and POWER conquers FEAR!!!!! We decided to share “ Our Journey” in hopes of helping at least 1 person!   If it helps more….   If it helps you!!!! That will truly be a blessing …   At no time are we writing to tell you what you must do, or what you should do….                                Your decision is Your Decision!! Just giving you a view of what decisions we made, what the process was for us, and the outcome as of this date.     Take care and know our thoughts and prayers are with you. In Friendship ~ Lee & Buddy

Kingsport,

I see that you have scheduled a Da Vinci at Vanderbilt. I assume that Dr. Smith is who you have scheduled it with. He did my Da Vinci on November 1st. If you have any specific questions about Vanderbilt or Dr. Smith let me know. The surgical experience was excellent.

Tamu

To SJC and B & C : I have an appointment at John Hopkins in January with DR. Su . Have you or anyone used him He is suppose to be top in Robotic surgery. Barister

Kingsport, If you had surgery today, I hope that all went very well. We too opted to travel for the robotic. We leave next tuesday and surgery a week from today. We are also traveling around the same distance, 6 hours, but have opted to fly. Good luck to you and will be watching for a reply with hopefully great news!! Courtney

I can not really see much advantage in Da Vinci.

I had open operation a couple of months ago and the problem post operation is urinary incontinence. This is result of damage to pelvic floor muscles and veins surrounding the prostrate.

The Da Vinci saves damage to muscles and tissue in the abdomen but it does nothing to save the pelvic floor or veins in the prosterate.

It is much more difficult for a surgeon to make a good job using Da Vinci and if there is accidental cutting of a vein it is much more difficult to control bleeding. 

Most important the surgeon can not feel any texture though the Da Vinci instruments. In my case the surgeons could feel the lymph glands and ascertain there was no trouble there, They can not do that in Da Vinci.

No doubt Da Vinci saves damage to abdomen, but this never causes a problem in open RRP; just read thes blogs and you will see no one ever has trouble with their abdomenal incision.

As said in many other blogs above your best bet is to find a surgeon who does many RRP at least two per week.

I hope all goes well

Bird6