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Robotic Surgery Is Questioned in New Study

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Posted 10/14/2009 12:30 PM (GMT 0)
Hi Guys:

This will undoubtedly add to the debate of open vs. robotic.  According to this study, there were more long term urinary and sexual problems with laparoscopic/robotic surgery than with open. 

There clearly may have been some reasons why...including lack of experience by the robotic doctors.  Anyway, read for yourself and decide.

Tudpock

http://news.yahoo.com/s/ap/20091013/ap_on_he_me/us_med_prostate_surgery

Posted 10/14/2009 12:49 PM (GMT 0)
I had traditional surgery so my dog isn't in this particular fight but it appears to me that what it really is saying is that practice counts.
The more surgery the doctor performs the better he gets at it and the better the outcome for the patient. Even the RDS doctor they quoted said
he took 700 surgeries before he got really good. I'd have hated to be #250 even though that sounds like a lot.
My doc had done over 2000 traditional surgeries. It simply means having a robot doesn't make you have better hands.
Posted 10/14/2009 12:52 PM (GMT 0)

Same discussion here:

https://www.healingwell.com/community/default.aspx?f=35&m=1614361

Posted 10/14/2009 1:10 PM (GMT 0)
Tudpock,

Good article and YEP you are right on the money, this will certainly fuel the debate for the next few months in all the journals associated with PCa and treatments.

We are just a small sampling here at HW and yet the results of every aspect of treatment, surgery in whichever form, rad, chemo and so on are different on every level.

I don't think anyone will ever find that there is one clear cut definitive answer for PCa treatment and quality of life issues.

When you look at the studied universe of 9000 from Medicare patients info, there is an entire world left out. Medicare suggests that all of the patients studied were 65 or over. How many 10s of thousands were left out of the study because they were under 65 and had private health insurance?

Every major hospital and Urology Institute in the country probably has almost as many patient follow-up as this study has. My dr has patient study info on 4500 da Vinci surgeries alone. I can only imagine that JH, Sloan Kettering, Cleveland and so on have similar numbers.

It is studies like this that only serve to muddy the waters not just with PCa, but with just about ever other medical disease and treatment as well.

My wife and I found this to be true with her cancer, Multiple Myeloma. Every one had their preferred method of dealing with it as well.

Bottom line is just the same as that which is stated time and again here at HW. You do your research, ask your questions, sift through the answers and make a decision on what you feel is best for you and you alone.

What a crap shoot.

Of course like everything else in life, this is just one man's opinion.

Sonny
Posted 10/14/2009 7:38 PM (GMT 0)
I would have to believe that men in there 40's and 50's would have a large bearing on this study I spent a lot of time with my doctor discussing the open and robotic nad he gave some pretty solid statistics for men in my age group comparing both pretty much there was slight differences I elected robotic mostly for the shorter recovery time I was also told that since I am a thin person by nature that it made me a better candidate for robotic. I did have some post surgery complications due to a hematoma that developed but that can happen in any type surgery and it thankfully resolved itself and caused a condition call Illeis (not sure if that is spelled correct) it is a condition where the bowels shutdown and go flat and I had to have a blood transfusion ended up in the hospital for 8 days but I have to say that prior to my surgery talking with 2 different doctors they both told me that these conditions can happen and with either type of surgery, I was just one of the lucky few that it did happen to.

I believe that either way is affective treatment option, the study to me looks a bit lopsided it needs to be spread out to cover all age groups to really have any valuable statistics to go from.

Just my thoughts
Posted 10/14/2009 8:57 PM (GMT 0)
Slammed might be quite strong. When you read the article it definitely states that surgeons with more experience have much better success. I believe that this was not a surprise. Anyone looking into DaVinci robotic surgery should definitely look into the physician experience. 1 to 200 is not enough. There is excellent success when the surgeon has over a thousand procedures...

Tony
Posted 10/14/2009 9:02 PM (GMT 0)
n addition,
The study lumped LARP with RALP patients and that just does not give a clear picture. There is a huge difference between LARP and RALP. The study clearly does not single out robotic procedures.

Tony
Posted 10/14/2009 9:26 PM (GMT 0)
Not sure what comments lead one to believe Robotic gets "Slammed" would be a conclusion to the article especially after this comment

"The data did not indicate how many of the less invasive cases involved robotics." It could have been less than 1%, it could have been 1 or 2 cases

A very ominous potential list of open surgery problems mentioned

"They also had lower rates of blood transfusions, breathing problems and internal scarring."

A lot of issues can arise from blood transfusions which would be a separate statistical addition to the findings. The same would hold true for breathing problems and scar tissue formation. None of the three is a problem with Robotic surgery

Yet another statistic that is missing is the duration of the surgery, my understanding is the open surgery is a lot longer procedure. My robotic was 1.5 hrs, thats a lot less time under anesthesia and the dangers associated with being under 3 times longer

The stats only point to Incontinence and ED
Posted 10/14/2009 9:51 PM (GMT 0)

My take is that this is a very flawed study with a lot of statistical noise rather than valid conclusions. 

One thing seems clear from the shift to the use of daVinci robotic vs. open prostatectomy, the manufacturer of the daVinci did a whale of a job  convincing physicians and the public of the superiority of this technology.  Whether it is better (independent of the surgeon's expertise) remains an open question.  

Posted 10/14/2009 9:52 PM (GMT 0)
Tud****,

It seems like you must have read the headlines without actually reading the article...

I don't see any "debate of open vs. robotic."  The article says to hire an experienced surgeon, and that during the years of the study there were a lot of surgeons learning on the robot.

Mass media likes to generate naive, gasping responses like yours, and (as an unfortunate result) their style of writing articles geared to the least common denominator of audiences who don't actually read the entire article.

Posted 10/14/2009 9:58 PM (GMT 0)
I think Tim has an excellent point. One of my doctors, a surgeon, said that he had to learn Robotic because many of his patients were demanding it, not because he thought it was any better. I think Marketing has much more affect on our treatment optons than any of us would like to believe.
JohnT
Posted 10/14/2009 10:11 PM (GMT 0)

TC-LasVegas said...
Slammed might be quite strong. When you read the article it definitely states that surgeons with more experience have much better success. I believe that this was not a surprise. Anyone looking into DaVinci robotic surgery should definitely look into the physician experience. 1 to 200 is not enough. There is excellent success when the surgeon has over a thousand procedures...

Tony

Tony

 We all generally agree that an experienced surgeon is important to a good outcome.  As I said in another post on this subject, the author showed no data that I know of that in any way rated the ability or experience of the surgeon.  Dr Wu then went on to say that  experience was very important.  He is entitled to his opinion, just like you and me.  However he was irresponsible to draw this conclusion without supporting data from their very badly documented study.

It makes me angry when the media picks up a story like this that will influence thousands of people, when the data is not good.  While I agree with much of what they say, they just used Medicare treatment numbers to assume their "facts". That and the fact that they did not separate robotic from non robotic laproscopic surgery, makes their study worthless.

http://jama.ama-assn.org/cgi/content/short/302/14/1557?home

I was only able to read the abstract as I do not have a JAMA subscription

Posted 10/14/2009 10:19 PM (GMT 0)
Might be an interesting unscientific poll here on HW.

Who had robotic, and who had open, and is there any perceivable difference in side effects .
Posted 10/14/2009 10:53 PM (GMT 0)

Sorry if I offended any delicate sensibilities by my Forum Topic; I have changed it to what some will find to be more politically correct.

I did not mean to make any value judgements about "keyhole" surgery, rather was attempting to share some information

And, Casey, assuming you stick around for a little while, you will learn that I do indeed read a lot of studies, including any that I post for information.  This article stated:

 " new study suggests less-invasive keyhole surgery for prostate cancer may mean a higher risk for lasting incontinence and impotence when compared with traditional surgery."

That IS a criticism of "keyhole surgery"...not my criticism, but that of the article.

I think some of you guys need to chill out a bit and understand that sharing of info, even controversial info is ok... rather than being concerned about a little hyperbole in a headline...but, again, that's just MHO. 

Tudpock


Posted 10/14/2009 11:13 PM (GMT 0)
I agree with the study in part, but again emphasize it is a bad study. I believe that many performing the DaVinci surgery are doing so by demand and that is indeed resulting in higher incidence of complications. This is a very valid point. As Lifeguyd says, we always place surgeon experience ahead of modality in making recommendations here. I know here in Vegas they added two Da Vinci systems recently, and you know what? I would not use those centers. The top doctor in Las Vegas has less than 100 RP's using that system. The doctor I chose had over 1500. My plumbing works well. And as of today I am approaching year 3 with a stage 3B cancer in remission.

I spoke with Mike Scott about this today during an interview I was in about Provenge, and he mentioned that it is very similar to a Brachytherapy doctor with limited surgical implantations and that with time the statistics improve.

Tony
Posted 10/14/2009 11:19 PM (GMT 0)
Sure glad I didn't have to be someone's learning curve with my surgery.
Posted 10/14/2009 11:35 PM (GMT 0)

Tud****,

 

Maybe you didn’t read what I wrote, either; specifically the part about “…during the years of the study there were a lot of surgeons learning on the robot.”

 

The study ran in the early- to mid-2000’s when most all doctors were coming up the robotic learning curve.  Most urology surgeons training during this time were training on the robot, while the older, more experienced docs were still mostly doing open surgeries.  (Of course, those learning the robot were also simultaneously doing, or learning—in the case of young docs—open technique.)  Almost nobody had vast experience on the robot; almost everyone during this time was coming up the learning curve.

 

So this study compared the results of older, experienced docs doing open to everyone new who was getting started on the newly available robotic systems. 

 

The article was probably written by some noob journalism major who graduated last semester who and never spelled “prostate” before last week, but likes to throw around the word “Slammed” just to get attention for his amateur work.
Posted 10/14/2009 11:45 PM (GMT 0)

Casey...dude...don't shoot the messenger.  Again, I was not personally making any value judgements about the "keyhole" surgery based on this article...I was just sharing it.  Personally I think the study is flawed work, but that does not mean it is not worth sharing with our brother survivors on this site.

Also, FYI, to gain any cred you might want to consider posting your stats after your signature like most of us do on this site.

Tudpock

Posted 10/14/2009 11:48 PM (GMT 0)
Casey,
Tudpock has not been harsh with his remarks and his post is relevant to this website. Constructive criticism is best directed to the writers not the readers. This is being discussed by the various groups and I am certain that this study falls short of useful data moving forward. The one exception is that anyone choosing surgery, should place the surgeon experience as the top criteria when selecting him. The same can be said for Brachytherapy, cryotherapy, HIFU, and virtually any person you would have work on you.

Tony
Posted 10/15/2009 12:09 AM (GMT 0)
Don't be so easily influenced, in knee-jerk fashion, to respond to a brief article about a study that should be carefully read - including the fine print- before coming to a judgement.  What I get out of the article is that the study was designed by researchers to slant the findings in a false and misleading way.  Bulls*it - full of bullcrap and such games do damage to the seriously interested researchers - and we patients.
Posted 10/15/2009 12:17 AM (GMT 0)

Hey Tud,

My comment wasn't intended to be a "shoot the messenger" as much as it was about "missed the message" of the article.  The message that guys visiting this board should take-away is about getting an experienced surgeon.  Unfortunately, the media-trap headlines misguides and alarms guys and does a dis-service when the interpretation shifts focus on a meaningless comparison of learning curve robotic results vs. experienced open results.  The article's author is a noob for setting this trap.  A credible interpretation of the article goes beyond the surface/headline.

By the way, is there really a "debate" on open vs. robotic??  A debate among whom?

Posted 10/15/2009 12:29 AM (GMT 0)

Casey...I still think you missed the message re my posting this at all.  I was not intending to dissect the article or the study or make any value judgements about it.  If you stick around and read my posts you will see there is no equivocation when I am stating an opinion or making a value judgement.  I was simply sharing...period...that's all and that simple...period...

And, yes, there certainly is debate about robotic vs. open...most surgery survivors on this site have opinions on that subject as do many physicians.  Why would you think there is not any debate?

Tudpock

Posted 10/15/2009 2:09 AM (GMT 0)

Q:  Why should there be no "debate" between open and robotic surgery...?

A:  The main point that readers should have taken away from the article was that open and robotic surgeries in the hands of an experienced surgeon yield essentially the same results.

This is about the ten-thousandth time this has been said.  Dr Peter Scardino, chief of surgery at MSK made this comment about the study:  "At the end of the day, what all the studies will show is that it's not the tools the doctor uses, but the experience and skill of the surgeon."  Are people really still debating this??

later...

Posted 10/15/2009 2:14 AM (GMT 0)
One of my neighbors relatives is one of the design engineers on the DiVinci robot. When I was diagnosed a couple of months ago he quickly put me in contact with him and shared the info given to him when he was diagnosed almost 2 years ago. The bottom line is that he was told that given his experience working with Drs developing and improving the DiVinci if HE were looking for a surgeon he would not even consider anyone with less than 1,000 surgeries and the more the better. He likened it to playing video games, it is Totally different than open surgery and the skills are difficult to learn. If you look at the statistics for Drs like Menon and Patel who have thousands of surgeries each (Patel has over 3,000 at this point) their stats are great. If you talk to them they will tell you that because of their reputation they get some of the most difficult cases which actually lower their stats. The problem is that all the Drs that are learning and may never get the "hang" of it are included in the study. I am having Patel do my surgery November 6 and have great faith. If I could not have him or Menon, Tewari or someone with similar experience I would consider radiation.
Posted 10/15/2009 3:16 AM (GMT 0)
Tudpock:

Notwithstanding the comments of Casey (who fails to provide any info on his PCa), clearly there is a debate with respect to robotic vs. open.  Just look at this forum.  Every month someone asks for guidance or info on that topic.

As to the study, I am thrilled that some researcher has paid attention to PCa, and has devoted time and a serious publication to one small aspect of the treatment.  Is the study bad?  Or, is it merely incomplete (according to some posters here, (a) the universe studied was not sufficiently large, (b) the data is skewed toward men 65 and older, (c) the study fails to differentiate between robotic vs. other laproscopic procedures, and (d) the study doesn't consider other important factors, such as less blood loss and reduced operating time).  But, aren't most initial studies incomplete.  Isn't that the nature of research, in that one study serves as a basis for further studies to correct the "flaws" or to examine the unexplored areas.

For most of us here, our situations are set.  We already have chosen one form of treatment over another.  But, don't we all want better data and info for those who follow us on this PCa journey?

BTW, for anyone who suggests that the experience of the surgeon, as measured by the numbers of procedures performed, is the only valuable info to be taken from this study, I note the following.  I had my daVinci procedure done by a surgeon who had performed 500 such operations.  Yet, 11 mos. later, I am totally incontinent and have ED.  Was it the surgeon, was it the procedure, or was it just me?  Studies on this topic may advance the info for those who follow.

RHC Jr.

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