Surgeon expertise

I've read that the learning curve is at least 300 RRP's. I was talking to the NP on my surgeon's team recently and I expressed my opinion that my immediate return to continence after my surgery has to be partially due to the surgeon's expertise. He felt that it is a factor, but there are other variables, and luck counts as well.
However, he said an inexperienced surgeon increases the chance of less than ideal return to continence. Of course that's just one professional's opinion.

When in doubt, go for the most experience. You only get one shot at a prostatectomy.

The head of Uro at my local hospital, the 2d largest system in the US, says that he did 150 robotic prostate removals before he truly felt he knew what he was doing and 250 before he was ready to tell someone else how to do it. Resident training, in other words.

Agree with tennisplayer and tarhoosier.
Dr. Karim Touijer at Memorial Sloan Kettering did mine on 10/31. He does 200 per year, over 2500 lifetime, and I think it due to his skill that my margins are negative and I am continent two days from removal of catheter.

Denis, sounds like you’re meeting with Dr Patel at Florida Hospital Celebration. I’ve posted about my good experience with his team if you want to search for it, & would be happy to answer specific questions. I’m continent at 12 weeks post RP, no pads, after being an open spigot the first week post catheter.
Also check out Dr Leveillee at Bethesda West in Boynton Beach. He came recommended to me by a uro at Cleveland Clinic and I had a positive experience when I spoke with him.

People say the more surgeries the surgeon has done the better. I am not so sure.
At some point 2000, 3000, 5000, (you pick it) the patient becomes a number and the surgeon is merely "phoning it in". I don't care how interesting or important the task at some point it becomes routine and dull. The importance and sense of urgency is diminished. Surgeons are human.

If someone said they had completed 12,000 surgeries I'd be looking for another. Remember, supposedly you are the surgeons patient "for life". With all those victims patients what must the office be like? Are patients stuffed in there like sardines? How much time do you have with the doc for the followup?

How do you know the 12000 number is real? Why aren't the surgical results posted some place? How many patients have ED? How many are incontinent? Can you get a recording of the surgery? The daVinci has the capability. Why isn't that a part of the record? Is the surgeon willing to give you a copy? Why not?

It's strange that we use word of mouth from a few folks for something as important as this yet we'll spend days looking at reviews and ratings for tires, flash lights, and power tools.

Some day there will be an Angie's List, Yelp, Google Reviews, or Apple iCut'em for this purpose.
Good luck!
Jeff

So should we feel sorry for the first few hundred or 1000 guinea pigs? I find it hard to believe that beginners don’t have an experienced veteran overseeing their surgeries and the vets doing thousands are not really doing them ; they’re supervising.
But clearly having either surgery or radiation at a high volume facility should produce better results.
Bob

According to Atul Gawande, assembly line medicine is definitely the way to go when it comes to the surgery itself:
https://utmedhumanities.wordpress.com/2014/10/14/the-computer-and-the-hernia-factory/
Patel’s office is always packed with patients, but I got compassionate, careful attention from his team at all stages pre and post surgery. My wife felt equally taken care of. I never felt treated like some widget in a car factory. Can’t speak for other high volume surgeons, seems right to worry that some might be dialing it in.

Maybe a very important factor is that the guy must be, first and foremost, and excellent surgeon.

My uro had been doing prostate surgeries the traditional way for many years prior to the introduction of the DaVinci machine His reputation as a skilled surgeon is well known.

When he did my robotic surgery, he told me he had done about 50 robotics. So, in light of the discussion in this thread, I was a guinea pig, so to speak.

All I can say is that my return to continence was very quick, and my PSA remains undetectable 7 and a half years later.

So, if a doc has no history of traditional prostate or other urologic surgery, having only used the DaVinci machine, then maybe hundreds of surgeries are necessary. But, if he knows his way around from years of actual surgical experience, that learning curve may be much shorter. He MUST be a good surgeon and possess certain skills.

Hundreds of procedures won't turn a bad surgeon into a good one, but they will make a good surgeon better.

Thanks I am not interested in being someone's learning curve.

A friend of mine just had it done by Patel and said the whole process was amazing and personal

I'm one of those freaks that's allergic to high dose radiation. I've been doing intermittent ADT and I feel fine but in time I'll have to have the RP so if you will, let me know how you do. My email is in my profile, Thanks, Phil