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Posted 9/15/2007 11:42 PM (GMT 0)
Hi all, still looking for more info.  In an earlier post I said I had decided on DaVinci surgery but now have backed off a bit after reading more of Dr Walsh ... that is one thick book.  One point Dr Walsh made regarding an advantage of open surgery is that the Dr can feel/see much easier than with the other two options.  In addition, he/she can take the prostate out to examine it and thereby be able to make a more informed decision on how to proceed.  (I got the impression that Dr. Walsh's prefered method is the open procedure.) With laproscopic and DaVinci, Dr Walch claims (2007 edition), neither of those two options are available, in practice.  To me, that is an important thing to consider.  In all other ways, is description seems make DeVince the better choice. 

Opinions or experiences?

Also, does anybody out there have any knowledge of how Kaiser Permanente of the Washington DC Metro area rates in this area?

Scott

Posted 9/16/2007 12:34 AM (GMT 0)

Scott,

I'm about to be offline for the rest of the weekend but thought I would add some perspective:

With your early detection & low numbers - and pre-diabetes,
  -both the reduction of trauma from surgery & decreased anesthesia with the da Vinci method should be weighted in your decision process.
On the other hand, family cancer histories (most importantly any history of your own) might weight the decision toward "open" and more scrutiny.

I had (ventral) open by default (as predicted) as my other surgeries since 1962 (appendectomy, inguinal hernia, laperotomy/spleenectomy after a car wreck, and post-laperotomy incisional hernia) left too many adhesions to complete the attempted da Vinci method. 
My 6 gleeson and (surprisingly) good physical health led me to seek out robotic laperascopy as the first option.
Buddy (Ms. Blue's Designated Hitter)  had a retropubic open prostatectomy (an open incision through the "crotch").  
Bluebird's journey has some very good information on their reason for choosing this method.
The reasoning seems to focus - as did your citations from Dr. Walsh - on a closer, manual  investigation of the tissues and organs. 
Some members here mention the magnification allowed with the da Vinci method.
I surmise a magnifier is also available in open.

Having been "opened" so many times, I would just suggest that you add a common financial tool to your decision process:
 - weigh the added risk against the expected value of the possible increase in information.

You of course can reduce the risk and uncertainties  
   -  by getting the best services. 
I am certain you can get excellent care at Kaiser Permanente.
However, just like choosing a da Vinci surgeon, if you choose open, make certain the surgeon you choose has done a lot of them. 

open is actually relatively rare now.  
Where before the surgeons flocked to watch a da Vinci, now the newer surgeons gather to watch as many opens as possible. 
There is always a chance the team will just open a patient, anyways -
  - and it is a very different procedure.
I personally had to choose a team with both a young "Jedi Knight" da Vinci artist -
   - and the more experienced "OB-1 Knobe" open Master.
(Yoda says: "Kegal three times a day until surgery, you must!) cool

Wishing you all the best.

CCedar
ICTHUS!

Posted 9/16/2007 12:47 AM (GMT 0)
Hi nscott.

I am glad you are researching your options. I don't want to give you my opinions just my experiences. I was wanting to have the robotic for all the reasons you can read on this forum. When I met with the robotic Dr. I told him I had sleep apnea. He then told me I was not a candidate for robotic. He sent me to a Dr. who did perineal surgery. I did not like the sound of that, which lead me to the Dr. who did my open surgery. I had my surgery on wednesday morning and was out of the hospital on friday afternoon. I was ready to go earlier in the morning but as busy as the nurses were I didn't leave until about 2:00PM. Pain was very low and I have not filled my pain prescription he gave me yet. I am almost 4 months out from surgery. Every one is different but don't be afraid of the open surgery. The catheter is a pain no matter what you do.

Good luck

Mika-mvesr
Posted 9/16/2007 2:51 AM (GMT 0)
Hi Scott,

I have a friend at Kaiser, and I will ask them. I'll get back to you as soon as I get in touch. By the way I had my daVinci prcedure at George Washington University Hospital. Great facility, and excellent staff.

Glen
Posted 9/16/2007 3:16 AM (GMT 0)
nscott,

Your research is the key to eventually reaching a treatment decision you are comfortable with. Despite what you get from us on this forum it is your confidence in your treatment provider and the type of treatment that will impact your decision.

In my case I had not read Walsh's book prior to reaching my decision to schedule Da Vinci surgery but I did read it after that and before my surgery. The surgeon that I chose is located at a university medical center and had done well over 3,000 open prostatectomies before starting to do the Da Vinci in 2004. He told me the reason he elected to start doing the Da Vinci was to prove that it was not as good as the open procedure. After having done enough to be able to compare the facts he became convinced that the Da Vinci was the better choice for those with early stage PCa. If the biposy results in a high Gleason along with a relatively high PSA then he will not do a Da Vinci and refers the patient to one of the surgeons on staff that do the open procedure. The primary reason he gives for the Da Vinci to be better then the open for early stage PCa is the great field of view that he has allowing for more preciseness in the nerve sparing and the bladder neck reconstruction. One of the posters to this forum likened this to the contrast between the surgeon having his eyes 12 to 24 inches from your prostate and within just a few inches. If you have not watched a video and a Da Vinci being performed you may want to add that to your research. There are several on the Internet that have been done by various surgeons.

Tamu
Posted 9/16/2007 10:54 AM (GMT 0)
Scott:

I had the same question a little over a year ago when I was diagnosed at 50 with early stage Pca: open or robotic/lap? I assumed robotic/lap after reading the hype on the internet. I spoke to a friend, who is a prostate research oncologist at a highly regarded cancer center in the Northeast and has no dog in the hunt. When I voiced my assumption to him, he replied, "Select the surgeon, not the procedure". You know what, he is correct.

I believe most who post here will attest the #1 criteria is selecting the most exemplary surgeon in terms of clinical experience/training and academic brilliance. A million dollar machine does not guarantee a successful surgery, nor does the "gold standard" open procedure. You've got to first have the expert before you get the advantage and better chance for a success.

My opinion: focus on the surgeon, not the procedure.
Posted 9/17/2007 9:33 AM (GMT 0)
I am going with open...in 3 hours as a matter of fact.  I was scheduled with a wonderful daVinci surgeon until I discovered that they go through the abdominal cavity and it has a risk of adhesions and therefore a risk of small bowel obstructions.  Having had these from another issue in the past, I truly don't need anything that can cause this.

Go visit Dr. Catalona's website.  He says laparoscopic surgery is actually more invasive than open.  And there's the issue of microstitches he can do vs. using caudery which he feels can damage nerves more.

Oh well, we all have to choose something don't we. 

Posted 9/17/2007 5:37 PM (GMT 0)

Good Luck 41

Hope your surgery went well.

I haven't read any articles by Dr Catalona.  However, if he made that statement regarding DaVinci being more invasive than open surgery, then I believe he is at odds with much of the medical community. Maybe his statement was made some years ago before the 1000's of DaVinci procedures showed it's effectiveness. With so many doctors making claims and offering their pet theories it can become very confusing. It is often difficult for the patient to find what is best. Good wishes on your recovery in coming months.

Posted 9/17/2007 5:52 PM (GMT 0)
Hey NS,

Well, you have found that there are many options for the type of surgery to have. I told my wife one day before my surgery that I wished there was only one way to take care of this disease. The options and information can be overwhelming.

My opinion is that the skill and experience of the surgeon is more important than the method used. You can find excellent results with both open and laproscopic surgery and you can find others that did not turn out so good. So ask questions. Ask about the surgeon's continence success rate and his/her ED success rate. These two items will be most important to you once the cancer is gone. Good surgeons have nothing to hide and should be able to provide these numbers.

I had open sugery and would do the same thing again if I had to do it over. I was dry the day after the catheter came out and now (9 months post-op) I have an active sex life with the help of Viagra and penile injections. My erections are becoming more and more natural and I now use very little Trimix in the injections. I take L-Arginine every day as well as 50mg Viagra.

So, that was my decision. Good luck with yours...

Jim
Posted 9/20/2007 2:08 PM (GMT 0)
nono  41/42

Hope ALL is Well!! You should be up & around in a few more days!  Just have to deal with MR. HANG!!!

Let us know how long he will be with you.  HEAL quickly, & welcome to the other side!!! yeah

Posted 9/20/2007 11:54 PM (GMT 0)
I had the Da Vinci surgery and I was told that they would open me up if the cancer was bad inside.  Fortuantely, my cancer was contained and the Da Vinci process really worked well for me.  I would recommnend getting a doctor who will do the Da Vinci surgery but open you up if necessary if your cancer has spread.  And, hopefully you will not need the later. 

I just have four 1/2 inch scars and one 1 inch scar from the operation.  I had no blood tranfussions during the operation which lasted 4 hours.  Last, they saved enough nerves that I am 75% the same as before the operation and my activities are about 90% as befoer the operation and it has only been 7 weeks since the operation. My current condition is much better then I ever expected.

But as others said you need to choose with what you are comfortable with.  Good luck wiht you rdecision.

Posted 9/21/2007 12:27 PM (GMT 0)
If my husband had decided to have surgery, we would have been very comfortable with Dr. Guarnaccia doing the DaVinci surgery (Kaiser/NoVA). Ultimately, though, he has decided to go with brachytherapy due to a number of factors.
Posted 9/21/2007 1:57 PM (GMT 0)
Good luck with brachytherapy. Each decision must be made on an individual basis. That is why I never advocate surgery to an individulal but am more than happy to relate my successful experience with the DaVinci. God's speed.
Posted 9/21/2007 2:21 PM (GMT 0)
Thanks, JCL. We'll keep you all posted. It's tough when there are multiple options that will achieve essentially the same results. You're right about it being an individual decision. Reading all the information and experiences everyone has posted here and elsewhere certainly has helped us to make the most informed decision possible for our situation.
Posted 9/21/2007 2:36 PM (GMT 0)
Each doctor has their favorite way of doing the surgery and will build a case for it. My original doctor who didn't offer DaVinci sited all kinds of data to support the open method including some of the same info you were told or have read. I had done a *considerable amount of research on the treatments available and when I questioned him about the DaVinci method, I realized that he actually knew less about it then I did. Never forget that in addition to being doctors, these are business people who are selling a service. If you don't choose their service, they don't get paid. Base on what my investigation showed, I chosethe DaVinci method.  There are a number of reasons that I could give, but those are my reasons not yours. Once I decided the cource of treatment, I searched for a doctor that was experienced using the DaVinci method. I utimately found one who, by early 2006, had completed about 300 of the procedures. He had published results for his first 200 surgeries which helped me decide to hire him to do my surgery. As other posters have said, it is important for you to make your own choice and in order to do that you need to do your own research rather than using our testimonials or one doctors opinion to make your decision.   *There are two highly respected medical centers, Baylor Medical Center in Texas and the Ford Cancer Center in Detroit that offer every treatment option for PC. Both of these centers have been using the DaVinci method for a number of years and both have printed statistical comparisons of the two surgical methods.  best of luck  
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