HealingWell
Search Close Search
☰

Robotic Surgery..but is it safe

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
12 3
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 6/15/2013 1:33 AM (GMT 0)
Very interesting off the news:

Rise in deaths and safety issues with robotic surgery

http://rockcenter.nbcnews.com/_news/2013/06/14/18958967-robotic-surgery-is-high-tech-tour-de-force-but-is-it-safe?lite

 

Posted 6/15/2013 1:38 AM (GMT 0)
I survived it.
Posted 6/15/2013 1:39 AM (GMT 0)
i don't think the issue is the robot, it's inexperienced and perhaps unqualified people using it.
Posted 6/15/2013 2:12 AM (GMT 0)
I think the rising numbers, since its becoming so widely used, is worth paying attention to. Just my personal opinion, not trying to make an issue, is that the open surgeon's arguments of tactile feel is still a strong argument. Experience is still the main factor in either of the methods, of course, that can't be disputed.

david
Posted 6/15/2013 2:32 AM (GMT 0)
Interesting article, but they highlighted one case where everything went wrong.

David, that's like using your case as an argument against radiation.

I was not impressed, and you certainly can't use the article's information to extrapolate anything regarding use of the robotic vs. open surgery for PC.

Mel
Posted 6/15/2013 2:40 AM (GMT 0)
Mel, I plainly stated that the tactile feel argument was just my opinion and I wasn't making it an issue.

The rising number of deaths is important, and can't be denied.

david
Posted 6/15/2013 2:47 AM (GMT 0)
Inexperience doctors is probably the reason for problems involved with the robot. That and the rise in its use.
Posted 6/15/2013 2:49 AM (GMT 0)
Another article, similar subject, with the FDA

http://www.outpatientsurgery.net/news/2013/04/18-Robotic-Surgery-Failure-Rates-Up-FDA-Wants-to-Know-Why

david
Posted 6/15/2013 4:26 AM (GMT 0)
Larger number surgeries being done, higher number of incidences. It would be so good if complications and injury could be held to zero regardless of the technique being utilized. Maybe someday...

 

Posted 6/15/2013 4:51 AM (GMT 0)
No method is 100% flawless.  Finding out the experience of your surgeon might make a difference.  Second opinions are important.
Posted 6/15/2013 10:11 AM (GMT 0)
I watched this show last night. The last line of the story summed up what they were trying to say. "The technology does not make a great surgeon. A skilled surgeon makes the technology amazing". One big point they were trying to make was that DaVinci machines were being sold at a high rate to hospitals with very little experience with them. the reason being was economic, because of all the publicity (and advertising) DaVinci machines receive, hospital feel they have to have one to appear "up to speed". The costs of the machines mean they HAVE to use them to justify the cost. Money over medicine. I thought they made it clear, that robotic surgery done by an experienced surgeon was a good thing, but like I've read here a million times, you want to find a guy with a LOT of experience and a good track record and not just depend on the machine to do the job.
Posted 6/15/2013 12:48 PM (GMT 0)
Robotic surgery is now used for more than just prostate cancer: my OB/GYN was just 'trained' using the robot for gynecological cancers as well as other female procedures. The robot is used by my husband's urological group for prostate cancer, bladder cancer, kidney cancer, and other urological issues. All 3 hospitals in our area now have the robot, including the small community hospital.

While I cannot argue for or against the robot for prostate cancer, I can tell you what our urologist felt in my husband's situation. The biopsy showed one positive area (this was the only Gleason 7 found at biopsy, with the others being a Gleason 6), right at the edge of the prostate and the uro was concerned about EPE (and he was right). He knew going in that he'd have to cut a wide margin around that area to get the best chance of a negative margin. Using the robot's camera, he was able to visualize the entire area before cutting and determined that the cancer had not breeched the capsule wall. The uro told us that he took his time using the camera to inspect as much as he could and, based on that information, formulated his surgical plan to cut much wider than was probably necessary. It worked in my husband's case because there was one single EPE found on pathology but margins were negative.
Posted 6/15/2013 1:44 PM (GMT 0)
Sephie, I was just the messenger sharing a news story. I don't limit the discussion in any way to PC use of Robotic, robotic is taking over so many Ops in the country, so the problem is probably way bigger than just in our PC world.

There is risk in any operations done any way, we all know that. Just thought since there is this "robotic wave" going across the country, as more and more data comes in, like all data, simply worth looking at.

david
Posted 6/15/2013 3:18 PM (GMT 0)
David I know you're just the messenger...wasn't planning on shooting you. It's a good article and there appears to be no doubt that the negatives of robotic surgery need to be addressed. An article I read said that there are now 1,300 hospitals in the U.S. who offer the Da Vinci robot as an alternative to 'regular' laprascopic surgery. The article also went to say that Intuit (the developer/distributor) of the robot has done an excellent job of not only marketing it to the medical profession but to lay people as well.
Posted 6/15/2013 3:27 PM (GMT 0)
I have no doubts from the developer, they would have every motivation in the world to want their machines to work right, and not have issues, especially to the patients on the receiving end.

Convinces me even more than before, that if you go robotic (no matter what kind of surgery), you need a surgeon with mega experience. I still think in 2008, my uro gave me good advice. His own partner was the only person in Greenville that had robotic PC experience, but he had only done 15 at the time, and I advised to stay clear, unless I was willing to go to Altanta. In my case, the whole subject is mute, because as it was, even had I had started out robotic, they would have had to convert it to open surgery regardless.

My official position, so that it doesn't get muddled: it's not the method of surgery, its the skill and experience of the surgeon.

david
Posted 6/15/2013 4:20 PM (GMT 0)
My official position, so that it doesn't get muddled: it's not the method of surgery, its the skill and experience of the surgeon.

David, I absolutely agree. I also think that a major factor needs to be the condition of the patient and the type of surgery being done. As my endocronologist said to me on our visit (when a radiologist said I needed a biopsy on my thyroid): "just because we can do a procedure doesn't mean we should do it." I like the guy for saying that, and for disagreeing with the radiologist and my PCP as I didn't need a biopsy.
Posted 6/15/2013 4:58 PM (GMT 0)
"just because we can do a procedure doesn't mean we should do it."

Wish all doctors felt that way.
Posted 6/15/2013 6:08 PM (GMT 0)
Sephie, Purg., et. al:

When I was first dx., I researched the heck out of all the tx. options. You might recall my posts at that time.

My conclusion was (and still is) that the two methods were comparable (there was a recovery/blood loss edge to the robot) and by FAR the skill/experience of the surgeon should be the determining factor. In fact, I narrowed it down to two excellent surgeons. One did both and the other did the robot. I decided on Dr. Menon after my interviews at length with both of them. I chose the SURGEON; not the METHOD. I might add that in my case, the surgeon that did both said that due to my specific situation, he would do it robotically (based on the location of the tumor, I think).

While I enjoyed reading the article, I don't think it was all that good as they focused on one horrible outcome. Seems to me one can easily find horrible outcomes in open as well as robotic surgeries (even with the best surgeons -- it happens!)

Mel

Posted 6/15/2013 7:36 PM (GMT 0)
Mel, unfortunately the media will focus on that one horrible situation where a patient had severe complications. And yes, if one takes the time, you can find horror stories about every surgeon, surgery, and hospital. Even the much-touted Memorial Sloan Kettering Cancer Center in NYC has had its share of surgeries gone wrong...the wrong breast removed, the wrong woman's breast removed, the wrong side of the brain operated on, etc.

And I agree with choosing the surgeon over the method. Our urologist did both types of surgery (open and laprascopic) and while he was leaning towards the robotic laprascopic, he did warn us that as the surgeon he reserved the right to switch to the traditional open method if he deemed it necessary. John had to agree to surgery under that condition.
Posted 6/15/2013 7:42 PM (GMT 0)
Mel, you keep focusing on the "one horrible" thing in the article. I am focusing on the sheer number of deaths and injuries with robotic surgery in general (not even thinking PC related). Other articles are starting to focus that the outcomes are not better with robotic over open, and robotic surgeries are generally more expensive. Saving hospital time seems like the biggest cost advantage if all goes well, and we all know how expensive a prolonged hospital visit can be. Guess like all things, there are trade offs that have to be considered.
Posted 6/15/2013 8:01 PM (GMT 0)
David:

The article itself (not just me) is focusing on the one specific horrible case.

In terms of the surgery, I truly have no opinion as to which one is better or even safer. That is still being hotly debated. My opinion is that there is no statistically significant difference. IS THE ARTICLE SAYING OTHERWISE? In fact, the emphasis still seems to be on the one horrendous case. Someone could write almost the identical article but slanting it towards a pro-robotic surgery viewpoint, emphasizing the shorter hospital stays and less blood loss.

A truly accurate article could compare experienced versus less experienced surgeons. In that case, however,

there is a HUGE difference when you compare surgeons: experience and talent wins out big time.

You have cited an article, but then suddenly complaining about the increased deaths resulting from robotic surgery. The article does not seem to directly address that issue.

The only reference to deaths is one sentence,  this: "The U.S. Food and Drug administration has received more than 200 reports since 2007 of burns, cuts and infections – including 89 deaths -- after robotic surgery."

Is this bad? How MANY robotic surgeries are done?? Certainly in PC, we do know that the great majority of surgeries are robotic surgeries. But the article talks about robotic surgery in general, not even PC robotic surgery. So, is this figure scary... or reassuring? Are there larger differences between open/robotic surgery for gynecological surgeries? What about other surgeries? There are so many questions not answered or even posed in this pablum article. The article is strong on sensationalism, but weak on information

More importantly, it may be that robotic surgery is being used in too many situations?? I don't know. I had my gall bladder removed 16 months ago. This same surgeon (the top surgeon in town) is now using the robot for gb surgery. Interesting.

My overall point is: focus on the surgeon and experience.

On another related matter:

When I was dx. with PC, I was at least able to gather some data on surgeons and draw some conclusions. Later on, when I had to do SRT, I found it impossible to compare radiation facilitities and, especially, RO doctors. The best I could do was look at the different innovations/machines. But an awful lot of claims appeared to come from the marketing departments. This is also true for robotic surgeries but as I said I was quickly able to find world class experts. Ditto with oncologists specializing solely in prostate cancer, but never with the RO's. Very frustrating. The RO's can easily hide their mistakes. As I said in another thread, my RO made it very clear not to see him if I later develop problems. When I was first interviewing him, he sure did emphasize how complications were so few and far between. HOW THE HECK WOULD HE KNOW! That's a different issue, but it is related to finding the proper expertise

Mel

Post Edited (compiler) : 6/15/2013 2:21:49 PM (GMT-6)

Posted 6/15/2013 9:51 PM (GMT 0)
The article reminds me of the Don Henley song, "Dirty Laundry" about how death and accidents sells news? "I make my living off the evening news, give me something, something I can use." or "we all know that crap is king."

Being a Da Vinci guy, I think this artiicle is like dirty laundry, not mentioning all the pluses of this surgical method.

2 months ago, I asked my surgeon, how does he do so many surgeries, doesn't he get fatigued? He told me when he did open surgeries, he could only do 2 a day, when he did laparoscopy, he could only do 1 a day, it took him 7 hours working in a bloody field and he was drained. With Da Vinci, he does not get tired and can see what he is doing so much better. His "team" prepares the patient and finishes up, he comes in when they tell him they are ready for him. Looking at his notes, he said he was with me for 70 minutes total.
6,000 successful surgeries later, no one in the world has done more than him.

Now I have positive margins. He told me my tumor was growing for approx.10 years before dx. It was what it was when he got me. I have a 20% chance of recurrence. But reading Walsh's book, he said to get the best surgeon because they know what they can do, how much to cut, before doing any more damage to the nerves or bladder. That much I have done. I found the best I could. If it comes back, oh well, we will deal with it then. For now, I enjoy the temporary membership in the Zero Club for as long as I can.

Doing a lot of surgeries is the key. Find that kind of doctor is your number 1 priority. Do your research. That is all you can do, then turn it over to the man/woman to do their magic.

Bill from Florida cool
Posted 6/15/2013 9:56 PM (GMT 0)
Let's put it another way:

This article is to reality as Entertainment Tonite is to News

Mel

Posted 6/15/2013 11:23 PM (GMT 0)
mel, I think you are over analyzing a very simple news story. it's not that big a deal. but still brings up a subject with some potential to pay attention to over time, as robotic surgeries of all types are on the rise.
it would be only natural to expect problems to increase with so many more being performed. doesn't prove one method is better or worse than the other, nor was that my intent to start that debate with this thread when I posted it. just a news story. nothing more.

bill, I think we all agree - its the surgeon, not the method, doubt anyone would debate that point. and positive margins are a funny thing. you have several, but so far, so good. I had one eeny teeny little one, and was told it would probably never been an issue, yet my surgery failed in roughly 9 months. based on my post surgery psa scores, I think it failed at 6 months. other men go for years with positive margin(s) and never show recurrence. I hope you stay free of that for many years to come, if not forever

david

david

Post Edited (Purgatory) : 6/15/2013 5:29:31 PM (GMT-6)

Posted 6/15/2013 11:28 PM (GMT 0)
mel, you were fortunate to live in this age to have your gall bladder removed in the way you did. I still have a 9 1/2" long curved and jagged scar (looks like a shark bite) from my gall bladder removal in 1981. A lot has changed in those 32 years, plus it required 10 days in the hospital and a long recovery, I was only 28 at the time.

david
✚ New Topic ✚ Reply
123