Why your DaVinci Uro should be experienced!

Some surgeons are just more talented than others. Surgical skills are like athletic skills in that some people have them and some don't. I could take a million swings with a baseball bat and I would never be able to hit like Willie Mays. Dr. Walsh gave an interview where he said that he could immediately tell if a young surgeon had the skills that would make him a great surgeon.

Frack,

I saw that interview on Charlie Rose. It was great. I imagine if Dr. Walsh could train all surgeons maybe the 1600 would drop down to 1599. LOL joking.

:)

JohnT: then I think we are agreeing actually, as its the quality, not the sheer number. You may have a sloppy surgeon that's done 1,000 surgeries, let's say mediocre quality, and a real pro that has only done 100 but was real precise and exact.

david

Guys:

What we seem to be overlooking is the surgeon's actual skill level, as measured by his percentage of positive surgical margins.

I went with a surgeon with over 1200 robotic procedures.

But I feel like I didn't press him enough about his rate of positive surgical margins.

Turns out his surgical margin rate was between 20 and 30 percent. He was pretty inspecific about this, and claimed that the centers like Johns Hopkins that have far lower surgical margin rates were artificially selecting their patients for better outcomes, etc.

That should have been a red flag for me, but wasn't.

I came back from surgery with a HUGE positive surgical margin.

I will likely forever feel that perhaps if I'd went to a surgeon with a known lower positive surgical margin rate then this wouldn't have happened.

Yes, number of procedures is important.

But in theory you could have a surgeon with thousands of procedures but just isn't actually that good, as measured by the number of positive surgical margins he comes back with, over time.

I was a guinea pig, to a degree, maybe, sorta, don't know really.

Anywho, my RALP surgery last week, was at a teaching hospital. I know that several doctors and students were in the OR observing and learning. My surgeon is a professor at the school and director of minimally invasive urology.

I'm six days post surgery. I think I'm doing excellent in terms of success and recovery. Maybe because they took extra time and care during surgery?
My only issue, and I believe it happens to all who have any type of surgery, is soreness and sometimes painful abdominal incisions, that are getting better day by day.

In all, I think doctors need to slow down and not be in such a hurry to jump on the latest bandwagon that rolls by.

My surgeon was Dr. Joseph Smith at Vanderbilt University Medical Clinic.  I looked locally and the surgeons had done 200 - 300 DaVinci's.  Dr. Smith had done over 3000 open surgeries before going to DaVinci and had since done over 5000 DaVinci's.  I thought the 3 hour drive to Nashville was well worth it. 

On the point of how many are needed to be a quality surgeon, that is hard to pin down.  I do know that 200-300 did not make me feel good.  I did not want my surgeon to go in there and say "Hmmmm I have never seen this variation before".

Also, Dr. Smith had a young female assisting him in the surgery.  He introduced her before they rolled me into surgery.  I would venture to guess that after that surgery they BOTH took credit for doing the surgery.  Thus possibly the first 200 or so are actually surgeries where they "assist" a far more experienced doctor.  Thus the patient gets quality care while the less experienced surgeon gets experience.   Just my $0.02.