Open versus Robotic surgery

Very recently there were a few studies published in medical journals in comparing outcomes for open, robot and laproscopic prostatectomies. The ones I saw showed that the robotic had superior outcomes (positive surgical margin, continence, ED, complications, etc.,)over open and laproscopic procedures once the learning curve was surpassed.



A Multinational, Multi-institutional Study Comparing Positive Surgical Margin Rates Among 22393 open, Laparoscopic, and Robot-assisted Radical Prostatectomy Patients.
http://www.ncbi.nlm.nih.gov/pubmed/24290695


Superior Quality of Life and Improved Surgical Margins Are Achievable with Robotic Radical Prostatectomy After a Long Learning Curve: A Prospective Single-surgeon Study of 1552 Consecutive Cases.
http://www.ncbi.nlm.nih.gov/pubmed/24287319


Robotic and standard open radical prostatectomy: oncological and quality-of-life outcomes.
http://www.ncbi.nlm.nih.gov/pubmed/24236628


Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes.
http://www.ncbi.nlm.nih.gov/pubmed/24223399


[Comparison of initial results with robotic-assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy].
http://www.ncbi.nlm.nih.gov/pubmed/24187850

I'd say its a wash, its all about the surgeon.

My "olde" Urologist said, "we have a brand new Da Vinci machine at our hospital!" and I thought "Yeah, and no one sufficiently trained to use it!" So I looked elsewhere and found one who had done a few hundreds of these DaVinci procedures!

Find one who cares about your post op wellbeing. If I may make an analogy: You don't want to a knee surgeon who is very adapt at knee reconstruction but not concerned with walking and gate! Its your prostate, your erectile nerves and your bladder so please select carefully.

I would recommend you talk to the surgeon about his training on the DaVinci, and give preference to one who has completed DaVinci training as part of their medical training. I would think that the surgeons who have not had proper training may be making the same errors over and over again. It is my understanding that some of the older surgeons have only had training from the manufacturers representative.

Of what use is it to select a surgeon who has done 2000 procedures if they have all been done incorrectly?

RCS said...
I would recommend you talk to the surgeon about his training on the DaVinci, and give preference to one who has completed DaVinci training as part of their medical training. I would think that the surgeons who have not had proper training may be making the same errors over and over again. It is my understanding that some of the older surgeons have only had training from the manufacturers representative.

Of what use is it to select a surgeon who has done 2000 procedures if they have all been done incorrectly?

Very good point. A DaVinci is a tool for a doctor to use. If a doctor doesn't know how to use that tool, needless problems can result. My surgeon had far less that the 2000 magic number of surgeries under his belt when he took out my prostate. He also had the use of DaVinci in his medical training. After surgery, the recovery went as he said things would be or even better than he described before surgery. It isn't the number of surgeries that is important. It is how skilled the doctor is in using the DaVinci.

I read that younger surgeons are often superior and have a much shorter learning curve because many of them are of the generation who grew up with video games.

Tom

I had open RP at Hopkins a little over two years ago. I have no side-effects other than preferring to take half of a viagra before sex. I could probably do without, and I do sometimes, but it's fool proof with it. That said, my doc offered robotic, but said he would prefer doing it the open way. I had no objection as I had already read that Hopkins still had a preference at this time for open RP. Plus, at barely 42, it was still the "recommended" method for men at my young age. I have a 5 inch scar below my navel, but nothing else to remind of the cancer. My PSA has been .01 since my first test and I remained a G6 with my post surgical pathology.

I would have likely opted for open anyway. I have to admit being skeptical of all the heralding surrounding robotic. I follow in my father's footsteps of trusting nothing in the first few model years. There was nearly a generation of open nerve sparing surgeries at Hopkins before I got there... seemed like a no-brainer to me.