Open vs. robot-assisted RP

but RAPR surgery requires a big expensive machine that takes lots of training to use. Big expensive has to be better.

I think when it comes to RARP vs open, you might be dealing with 3 different cases of surgeons:

1. open practitioners--I would suggest in most cases, these are experienced surgeons who were doing open surgery before the robots came into the system. In some cases (my diagnosing urologist is one), he practiced at a small town hospital that lacked the capital money to invest in a robotic surgical suite. His comment to me was, "The hospital isn't going to buy it because it won't get used enough (by anyone, not just by him), plus I don't want to ruin my reputation by having to do several hundred procedures to learn how to use it" In short, you have great and near-great surgeons who were doing open long before the robots came in--and they saw no advantage to making the switch--and didn't. They will argue all day that they are better than the robotic surgeons--and it's all opinion. The facts don't work either way.

2. This case is interesting to me--and my surgeon falls in this group: Experienced surgeons who were doing open surgery before the robots came online, and who made the switch. I personally found this attractive. The idea being that if there was a problem during the robotic surgery, they could switch to doing it open. Plus, I liked the idea of a broader range of experience--the surgeon who has probably 'seen it all' is the one I wanted.

3. Then we have the surgeons who have trained exclusively on the robot. They may have never done a true open surgery--even a basic appendectomy these days is done laparoscopic. I'm sure the training is done with dual control units--with the teaching surgeon on one set of controls, and the student on another set. And, by the time the student (is apprentice a better term?) has complete training and gotten the experience, I'm sure their outcomes, as a group, will be as good as the old hands.

So, in my mind, it really does come down to experience. Which really does beg the question: If it takes 'hundreds' of surgeries to get a track record and get really good at it--which I don't doubt--how do the newcomers get that track record, if everyone automatically goes to the highly experienced? (this is the same argument that applies to all employment decisions: If only the experienced can get hired, then how do you get experience? )

A urologist told me "it's a deep and dark hole" for open surgery - the prostate is really buried in the pelvic area. I'll take laparoscopic surgery over open for any operation - less tissue trauma and faster recovery.

but do you open your egg on the big end or the little end?

Either way, prostate surgery is one of the most difficult and delicate surgeries performed. The brain surgeons joke about it saying they have it much more easy task operating on the brain than do urologists removing the prostate. John's comment helps clarify.

That men and their docs often demonstrate such a seemingly cavalier attitude toward RP has always amazed me. Just because it is frequently performed doesn't make it easy.

TA nailed it. It comes down to the surgeon and with what procedure the specific surgeon is best.

Hal, as I understand, the open is taught first. My surgeon that just performed a robotic assisted inguinal repair explained this to me. He first learned open, then laparoscopic then robotic assisted. He specialized in laparoscopic in residency and he reported the learning curve from open to laparoscopic was rather steep, but from laparoscopic to robotic assisted was a breeze.

He gave me my choice between the three methods and said all work well. I asked him what he as a surgeon wanted to use and he replied the robotic assisted for a number of reasons. So that is what we did.

MK, Andrew, as is his tendency, was making a joke out of the question: The preference about which end of the egg to open is similar to the question about which is better--robotic or open.

If you have ever eaten a soft-boiled egg from an egg cup, which end do you place 'up' in the egg cup? (do people still eat soft boiled eggs?) And do you prefer a 3 minute or 5 minute egg? And do you place the egg in cold water and bring it to a boil, or do you lower it into boiling water with a spoon? And when do you start timing?

Gulliver's Travels by Jonathan Swift. Island of Lilliput...

sarcasm/humorous comment on pointless wars and giant people stepping on little people.

Eggs have a small air pocket inside the shell at the big end. opening an egg at that end results in less spillage and provides better access for a spoon. For this reason I have always supported Biefuscu over Lilliput in the matter of endianness although I concede that it is a silly thing to fight wars over.

Additionally, the notion of endianness is used as a metaphor for storing and transmitting numbers on computers. Computer brands differ in whether the high-order bits or the low-order bits are stored first (at the smallest address) in memory. In most cases this doesn't matter since the task of storing and retrieving the numbers is handled by the hardware but it can be a problem when binary data must be serialized for transmission between systems with different native endianness.

As for open vs robotic surgery, the results I remember seeing show a tiny advantage for robotic (on average, industry-wide) but it is vanishingly small compared to the variations between surgeons.

But still no one has answered the question--what is the right way to soft boil an egg? My rules, taught me by my mother--who knew what SHE liked:

1. Boil the water to a full rolling boil.
2. Use a needle to poke a pin hole in the large end of the egg
3. Allow the egg to reach room temperature (at least 10 minutes out of the fridge)
4. Gently lower the egg into the boiling water with a spoon.
5. Start the timer immediately, and boil 5 minutes.
6. Remove the egg with the spoon and hold under cold water for 30 seconds.
7. Place in the egg cup, large end up, crack open, and enjoy with a sprinkle of salt and a piece of buttered toast.

https://www.drugwatch.com/davinci-surgery/

Look at complications link in there.

I need inguinal hernia repair. New local hospital, with the robot, surgeon wants to use it, he's done less than 75. So I would be part of his learning curve. Don't think I'll go robot

Not to mention the pending lawsuits over the defective mesh used

Post Edited (Fauntleroy) : 8/9/2018 3:19:12 PM (GMT-6)

Fauntleroy,

I just had robotic inguinal repair. The studies I read showed that once a surgeon is adept with laparoscopic then the learning curve for robotic assisted is only 25. I wouldn’t shy away until,I learned more about the surgeon. Inguinal repair is in no way comparable with RP.

A robot doesn't make a surgeon better, experience does. And Gary, Dr. Carter did mine at Johns Hopkins 3 years ago tomorrow. Other than it all sucks, I can't complain about my results thus far.