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Please help me with final decision.

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Prostate Cancer
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Posted 9/22/2007 4:16 PM (GMT 0)
After much research and consultations, as well as discussions w/ my insurance company, I have narrowed down to two surgeons who are in network. I would have to travel for either surgeon but I don't want that to be a deciding factor.(although one is in Balt,Md and the other is here in Tx where I live) They both seem qualified but have very different resumes. I would be very grateful for your opinions . I have a tentative schedule w/each so I need to decide this weekend. It boils down to an excellent surgeon(Dr. Su) from a very pretigous hospital but with less actual robotic surgeries vs. a younger guy(Dr. Fagin) who has put up a crazy number of Da Vinci procedures in a short amnt. of time. I am a little concerned w/Dr. Fagin doing 4 surgeries a day @ 1-1.5 hrs. a piece. Does this mean they are cookie-cutter style vs. Dr. Su's 2 a day @ 2.5 hrs. a piece? Or does it mean Dr. Fagin is just really good and more efficient because of having done 600+ surgeries? I know there are many variables I can't control, I want to make best choice possible for my doctor. Thanks very much for your help!
Here are their bio's:
First the big gun-
Dr. Li-Ming Su -Associate Professor of Urology
Director of Laparoscopic and Robotic Urologic Surgery
James Buchanan Brady Urological Institute
Johns Hopkins Medical Institutions , BS/MD @Cornell University,Residency@Memorial Sloan Kettering
He has done 335 conventional lap procedures beginning in 2000. He will have done about 250 Da Vinci surgeries by my appt. in mid Oct. He does only 2 surgeries a day 3 days a wk. His surgery time is 2-3 hrs. He claims continence is 90% at one year. Potency is 75% at one year. He incorporates some of Dr. Walsh methods in his surgery.Is highly published and I would guess has learned from some heavies in prostate cancer, not to mention he is at the #1 hosp. in the country. He assures me he will do my entire surgery (no assistant/students at the console).


Now a guy who practices w/ a small private group called "The Urology Team" in Austin ,Texas.They purchased a robot and brought him in June,2004.
Dr. Randy Fagin attended medical school at the University of Buffalo in Buffalo, New York and joined The Urology Team from Syracuse, New York where he obtained his training in Urology. Dr. Fagin has trained with experts in Laparoscopic Urology in Paris, France, The Cleveland Clinic, New York University, Albany Medical Center, and Thomas Jefferson Hospital in Philadelphia.(I believe these were short training sessions) Dr. Fagin is currently the director of robotic surgey at St. David's Medical Center (small-ish Hosp. in Austin). He does not have the strong academic writings and bkgrnd of Dr. Su .He does seem to have impressive numbers performing daVinci robotic prostate cancer surgery. He performed 200 Da Vinci surgeries between 2004-2005. He claims to have performed 100 trad. open surgeries,300 trad lap. procedures and currently 600 Da Vinci procedures.He does 10 a wk - 4 a day Mon and Fri and 2 a day on Wed.
Posted 9/22/2007 5:08 PM (GMT 0)
The standard advice is the more actual surgical experience the better. The difference between your two candidates is pretty dramatic -- 250 vs. 600. But I wonder if the "experience factor" weighs as heavily once you get 200-300 DaVinci's under your belt (no pun intended)? My surgeon told me he does 2-3 surgeries a day, 3 days a week -- about 250-300 a year, the majority DaVinci. He also said that 2 to 2-1/2 hrs is pretty standard. I'm suspicious of the 1 to 1-1/2 hr prediction-- sounds a bit like an assembly line, if it's true. Doing 4 a day, day after day, would also concern me. I guess I wouldn't want to be #4 on a Friday! I dunno. This is a tough one. I'm a sucker for impressive credentials -- I'd probably to with the John Hopkins guy, but you're probably in very good hands with either one. Good luck and keep in touch!
Posted 9/22/2007 5:15 PM (GMT 0)

Hi laswell,

This is a tough one.  You have a choice between good and good.  My only concern, which you seem to have addressed, is the notion that Dr. Fagin seems to have a kind of "factory" going, where surgeries are done one after another in a short period of time.  You'd want to feel comfortable that Dr. Fagin and Dr. Su would both take the time to pay very close attention to your specific disease situation and anatomy once inside your body :-)

If you feel comfortable with the individual attention you'll recieve, and you have some good second, third opinions on each surgeon's effectiveness for this surgery, then it probably doesn't matter which one you choose.  Again a choice between "good" and "good."  You are in control

I wish you the best in your decision and treatment!

Kind regards,

Idaho

Posted 9/22/2007 6:05 PM (GMT 0)
Hi Laswell

It might well be a toss up between the two doctors. However, I am very skeptical of any doctor who claims to do 4 robotics surgeries per day at an average of 1-1.5 hours each (i.e., Dr. Fagin). From what I have read the average time to do each one is often well in excess of his time frame. There are more complicated surgical cases where it can take a few hours to complete the surgery. You need to clarify this point very carefully. Also, you might see if you could get some references from some of his patients who have had surgery awhile ago.

Keep in mind that the doctors who specialize in prostate cancer at Johns Hopkins have long had a superior reputation and I wouldn't be overly concerned that Dr. Su has done fewer robotic surgeries than Dr. Fagin. He seems to have done enough to give him adequate experience. I know that getting your surgery performed locally would be preferable, but I wouldn't let this point be a deciding factor. The rule given by most prostate cancer experts is not to settle for less than the best doctors at the best hospitals.

Good Luck to you!

Dave
Posted 9/22/2007 6:39 PM (GMT 0)
Fagin has a decent reputation. Li-Ming does have one plus that caught my eye...the focus on both lap and robotic assisted laps. That would probably be a selling point over Fagin. Either sounds like a winner actually. You'll get it figured out. Good Luck and best wishes.

swim
Posted 9/22/2007 7:02 PM (GMT 0)

Dear Laswell

      If you check my last post (today) you will see that I went through a similar decision- making process except with a set of equally good Robotic surgeons. Both Su and Fagin are excellent from my research. I tried to get appointment with Su but it took too long for appointement. I also heard that his surgery schedule is out to December/January now since he is cutting back on Robotic prostatectomy rather he started involving himself in other areas of robotic surgery (not sure area). I also was under impression that Su was one of the 1000 club in terms of number of robotic surgeries. If I did not opt for David Lee from Penn here in Philly (my home town), I would have chosen Tewari in New York. Both are excellent and I agonized as you over which one. Ultimatley it boiled down to being close to home with all other things considered equal. As for length of surgery - you have to be sure what time reference they are using - the acutal time doing robotic procedure or the total time including prepping you. I found that  2.5 hours included prep time and heard a range of time from 2.5 to 3.5 hours from the doctors I spoke to. By the way, although Hopkins is a great facility with great doctors who have done wonders for many in the Forum and elsewhere, there are many good surgeons around the country including your home town. I did not like my experience at Hopkins - the surgeon I met did both open and robotic (he even referred to Walsh's book as out of date)and  suggested to me that open was less invasive then robotic and was somewhat dismissive. While he was a well known and highly regarded urologist at Hopkins, for me - he was not the answer. As everyone  tells you - it is your decision - go with what you feel most comfortable with. I met with every surgeon I considered before I made my decision which included travel to NY, Columbus and Baltimore.  I wanted a personal meeting with each before deciding. Perhaps that is what you should do. Good luck.

CPB

Posted 9/22/2007 8:39 PM (GMT 0)
Hey laswell,

You have thoroughly studied your options. Now take a day off then go with your gut....

Jim
Posted 9/22/2007 10:57 PM (GMT 0)
laswell,

There have been a couple of posters to this forum that used Fagin. Hopefully they will pick up on your post and reply. One of the unique services that Fagin provided was a physical therapists that specializes in helping to learn the right muscles to train to recover continence. As to the time for surgery I am not sure that there is any particualr standard. My surgeon had done over 900 Da Vinci's and 3,000 open type of prostatectomies. He does about 11 a week in three days and is the head of the urology department of a major university based medical center. I was told that my surgeyr would be about 3 hours. The day I had my surgery three were scheduled but at the last minute one was cancelled due to pre op complications. I was the first one done that day and when I woke up in recovery it had been about 4 hours since I had entered the OR. I asked my surgeon why it took longer and he just said that my prostate was large and he just decided to take the time to do as good a job as he could. I appreciated his commitment to doing a very good job.

Tamu
Posted 9/23/2007 2:45 AM (GMT 0)
You now have the hardest part to do, choose a surgeon. I opted for a surgeon who had done a fellowship with Menon and trained another surgeon in the Da Vinci. My surgery was almost 5 hours. I asked the surgeon about t his and his reply was there were certain things that needed to be taken care of, he also made the statement "I don't want any one or two hour prostate surgery done on me". Seems that his concern was less than two hours was rushing things. You are welcome to go to my thread and see how things have gone for me. I have tried to update my situation regularly. I am now nine days into a ten day coach trip and things are going fine. I have ridden over 2500 miles the last few days. No problem. God Bless, Uncle Dan
Posted 9/23/2007 1:43 PM (GMT 0)
Hi, Las - good for you on scheduling a visit with your two choices in surgeons. We selected Dr. Fagin based on his availability for discussion, credentials and face-to-face impression. He took 2.5 hours with the actual procedure. (And our opinion going in was the less time under the knife/anesthesia, the better.) In other words, he won't rush through, which would be common on any physician's schedule, I imagine. We liked the fact that he was younger - we joked with the staff about him teething on a game console. He also seems to have boundless energy - his first rounds post-surgery started at 5 a.m.

A second plus is his post-surgical rehab program - he's eager to see men of all ages return to as much of a normal life as possible and does everything in his power to see that it happens. His team is exceptional; the hospital is equally outstanding.

Third, he took us even on Medicare, which is basically hideous when it comes to reimbursing a fair amount. And he continues to have us come back for rehab discussions and PSA checkups, in spite of that.

You'll be in great hands, whoever you choose. We know these decisions are not easy. Good luck.
Posted 9/23/2007 7:15 PM (GMT 0)
Sounds like one is doing piece work and the other is doing quality. I don't want a dr in a hurry to get to the next operation as it is a life he is messing with
Posted 9/24/2007 12:04 AM (GMT 0)
Laswell, I'm with Biker. Take a day to let things settle in.  Go out and have a nice meal and some wine.
Then, put it in the hands of the higher power and your decision may come to you.

I'm no holy roller, but when I was at the crossroads (very scared and confused) I put it in the hands of God one night and my path arrived the next day.  Before I knew it, surgery was over and healing was underway.  I've never looked back on my treatment/doctor decisions.

Best to ya.
You'll be fine.
Tom

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