Potential Complications relating to Laparoscopic/Robotic Surgery

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pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 5/27/2008 6:10 PM (GMT -6)   
I read the following article which appeared in today's New York Times, which should be of interest to this forum.  I was somewhat surprised by the article--this being the first time that I had ever heard of potential complications from scar tissue forming in the areas where the surgical instruments are inserted into the body during laparoscopy prostate surgery, including robotic surgery, which is a relatively new and fast growing treatment for PCa since the early 2000's. 
 
May 27, 2008
 
Mixed Outcomes in Laparoscopy for Prostates
"Laparoscopic operations for prostate cancer, a minimally invasive surgery that is in rising demand, result in fewer immediate complications and quicker recovery than the more common open procedure, a new study reports. But the surgery increases the chance for longer term problems that require further therapy, the research says.
The widely advertised procedure is becoming more popular, said Dr. Jim C. Hu, the lead author of the study and an instructor in surgery at Harvard.
“This paper,” Dr. Hu said, “demonstrates that there are hidden risks for patients who opt for laparoscopic or robotic surgery.”
In laparoscopy, a surgeon inserts instruments through small cuts in the skin instead of making large incisions to expose the organs. The laparoscope is a slender tube that allows the surgeon to see inside the body. Most minimally invasive prostate operations are robot assisted.
 
The study, published on May 10 in The Journal of Clinical Oncology, examined a sample of 2,702 Medicare patients undergoing radical prostatectomy, the complete removal of the prostate, from 2003 to 2005. Minimally invasive procedures increased to 31 percent of all radical prostatectomies in 2005 from 12.2 percent in 2003.
 
Laparoscopic surgeries — the study does not specify how many were robot assisted — resulted in a 27 percent lower risk of complications during and immediately after the operation. Those patients had less bleeding, fewer breathing problems, fewer cardiac problems and fewer immediate complications over all. The patients needed an average of 1.42 days in the hospital, compared with more than four days for those who had open surgery.
 
But the men who had the laparoscopies had a 40 percent greater risk of scarring that interferes with organ function, a complication that requires additional surgery. And within six months of their operations, more than one-quarter needed additional hormonal or drug therapy compared with one in 10 of those who had conventional surgery.
 
Dr. Mark L. Gonzalgo, an assistant professor of urology at Johns Hopkins who was not involved in the study, said the laparoscopic procedure had disadvantages. “You can’t feel the cancer in robotic operations,” he said. “And the ability to feel the cancer with your hands may provide some additional advantage.”
 
Even in robotic procedures, he added, “the operation is performed by the surgeon, not the robot. You have to have a surgeon who understands the anatomy.”
 
At Johns Hopkins, Dr. Gonzalgo said, the open procedure continues to be used in most radical prostatectomies.
Other experts found the study noteworthy. “It’s a very important paper, the first that has come out in the field that has used a national database to examine outcomes,” said Dr. Peter T. Scardino, chairman of the surgery department at the Memorial Sloane-Kettering Cancer Center.
The study has some problems, he said, noting that data on the seriousness of the cancer in each case was not available, leaving no way to know whether less serious tumors were consistently selected for laparoscopic surgery. Still, he said, the results “fit with everything we know.”"


-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo), 1.6 (12 mo.).  Radiation oncologist said: the 3-mo. drop of 70% exceeded expectations; the slight 6-mo. bump up was not a cause for concern now; expected drop in 12-18 mo. is 75%.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 5/27/2008 6:18 PM (GMT -6)   
Hey Dave,

Interesting article. My RRP was my 8th abdominal surgery and I can testify that they do cause scar tissue to form. In fact, I had some concern about RRP because of the prior surgeries but the doc said it would not cause a problem and apparently it didn't. However, I think it should be a consideration in making a treatment decision.

Thanks for the info...

Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + 1000 mg L-Arginine + .03 cc Trimix = Excellent Results
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
"Patience is essential, attitude is everything."


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 5/27/2008 6:56 PM (GMT -6)   

Hey Jim

So nice to hear from you and get your comments from your personal experiences which are always of tremendous value to all of the members and readers here.  I never dreamed of potential scar tissue issues with robotic surgery which I almost opted for.  You were really a brave guy who elected an open radical prostectomy, which many still contend it the best surgical option.  All the best to you Jim

Dave


-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo), 1.6 (12 mo.).  Radiation oncologist said: the 3-mo. drop of 70% exceeded expectations; the slight 6-mo. bump up was not a cause for concern now; expected drop in 12-18 mo. is 75%.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 5/27/2008 7:10 PM (GMT -6)   
Hi pcdave,

Thanks for the interesting article. The info is quite surprising to me. I had the open procedure, but only because the laparoscopic one was not available in my area and I didn't have the option of traveling to far. I was in the hospital for 4 days, but had no complications and recovered quite nicely. Now, if only I could keep the darn PSA at bay I'd be a happy man.
Wishing you well.

Magaboo
Born Sept., 1936
PSA 7.9
Stage T1C
-ve DRE
Gleason's Score 3+4=7
2 of 8 positive
Open RP 28 Nov 06
Post op staging T3
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06
Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA test Mar., 08 =.04 
 
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2301
   Posted 5/27/2008 7:23 PM (GMT -6)   
Interesting study, Dave.  Mine was performed the old-fashioned way, open rather than by robot. I don't regret it although the hospital stay was a little longer--4 days rather than the 1-2 typical of robotic.  No regrets and still cancer free.  The key in my case was that the cancer was caught very early, so it really wouldn't have mattered which treatment I chose--slash, burn, freeze or blast.

Age 59  PSA quadrupled in 1 yr (0.6 to 2.5) 
DRE neg  1 of 12 biopsies pos (5%) 
Open surgery June 2006 
Cancer confined to prostate (1 pea-sized area) 
T2a  Gleason 5 (3+2)  PSA < 0.1  


jrponalameda
Regular Member


Date Joined Dec 2007
Total Posts : 56
   Posted 5/28/2008 6:29 AM (GMT -6)   
A very interesting article! I had the DaVinci and while I haven't had any issues as mentioned in the article, it's a good 'heads up' to watch out for problems. If I run into scar tissue problems or other issues from my DaVinci I'll certainly post them, and I'd appreciate it if other DaVinci 'veterans' would too.
 
 
Diagnosed Sep 2007 Age 54 Gleason 6 (3+3)
DaVinci Surgery 11/8/07 University of Minnesota
2/22/08 PSA Undetectable


lvdgs
Regular Member


Date Joined May 2008
Total Posts : 70
   Posted 5/28/2008 9:30 AM (GMT -6)   
Dr. Hu performs Robotic Surgery at Bringham and Young in Boston. I was given his name should my husband decide to go that route and want to travel to Boston.  

StrictlyInc
Regular Member


Date Joined Dec 2006
Total Posts : 357
   Posted 5/28/2008 12:19 PM (GMT -6)   
How does one know if they have the scar tissue problems mentioned in the article? Is that something one could feel?
____________________

Prostate cancer diagnosed: May 15, 2006 (age 40)
Gleason score: pre-surgery 3+3=6; post-surgery 3+4=7
daVinci radical prostatectomy: July 25, 2006
size of tumor: approx 1.1 inches; negative margins from surgery

- number of pads/day at 3 months after surgery: 3 to 5
- number of pads/day at 4 months after surgery: 1 to 2
- number of pads/day at 6-18 months after surgery: 0 to 1

- 1st post-surgery PSA: 0 (Nov 2006); 2nd post-surgery PSA: 0 (Feb 2007)
- 3rd post-surgery PSA: 0 (May 2007); 4th post-surgery PSA: 0 (June 2007); 5th post-surgery PSA: 0

The search for timber: took Viagra/Cialis approx. every other day, ErecAid once a day, injections. Peyronie's diagnosed 7/5/07. Now on daily Cialis, L-arginine and pentoxyfylline. Peyronies has stabilized and significantly reversed.

- PGE1 batting average: .364 (4 for 11)
- Bimix #3 batting average: .722 (13 for 18) Bimix #1 batting average (11 for 11) = 1.000
- Trimix batting average: .500 (1 for 2) Grand total 29 for 42 = .690

"Lost in the valley without my horses, no one can tell me what my remorse is..."


KrisP
Regular Member


Date Joined Mar 2008
Total Posts : 162
   Posted 5/28/2008 6:08 PM (GMT -6)   
I forward the article to my surgeon and asked him of his thoughts. He asked me for my phone number to discuss the article. We'll talk tomorrow.
Biopsy done 3/2008
Pre surgery: Gleason 6 (3+3), involving left lobe
DRE=15gm with indurated left base and mid prostate
Cores positive: left base medial, left base lateral, left mid medial and left mid lateral (4 of 12)
Clinical stage t2b.
Prostate Carcinorna 185
DaVinci Surgery on 4/21/2008 in Austin by Dr Randy Fagin.
Pathologist report upgraded to a Gleason 7 (3+4)
Clinical stage upgraded also to a T3a
Margins Clear

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