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Regular Member

Date Joined Jan 2009
Total Posts : 71
   Posted 4/28/2009 3:28 PM (GMT -6)   
I posted earlier about choosing between surgeons. The feedback agreed to go with the most experienced surgeon. Now I find out that the hospital with the supposedly more experienced surgeon would also have a resident performing at least part of the surgery because it's a teaching hospital. At both hospitals, the main surgeon has lots of experience. The hospital for robotic surgery said that the experienced doctor would be running the robot, but the resident would be assisting. Is this a lot different than having the open surgery performed by a resident with the experienced surgeon supervsinig? I'm not sure I trust that the robotic surgery hospital is being straight with me about how much of the operation the resident would be doing. Any feedback is greatly appreciated.
SO diagnosed 4/15/09 age 47
PSA 10
Right side= Gleason 4+4=7, 40% involved, 5 out of 6 cores positive, perineural invasion present
Left side+ Gleason 4+4=8, 60% involved, 5 out of 6 cores positive, no perineural invasion present

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 4/28/2009 3:36 PM (GMT -6)   
Dana....I don't know exactly...I know that in robotic, there is an assistant...but from what I remember only one surgeon is at the console that operates the robotic arms and I would think that is the guy that needs to be well experienced. I would imagine that an open surgery is similiar. I think that when you have major surgery, two surgeons are always there, with one being the lead the other assisting or learning.

BTW...a teaching hospital can be a good hospital...I know the one here in Dallas that I used for skin cancer was great...even though I had a full team of surgeons around me during the surgery...memory was 8 I think...but the point is, a teaching hospital should not scare you away.

Lets see what the others say on this...

You are beating back cancer, so hold your head up with dignity
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 4/28/2009 5:23 PM (GMT -6)   
The robotics surgery team usually consists of the surgeon on the controls of the machine, usually removed a few feet from the patient, a resident at the patient who assists the surgeon by adding or removing the various attachments to the robot arm, helping insertion, removal of instruments and probably closing of the wound after. A nurse is also present with the patient to document paperwork, assist the resident, also an anaestesiologist (misspelled badly).
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

Forum Moderator

Date Joined Sep 2008
Total Posts : 4274
   Posted 4/28/2009 6:59 PM (GMT -6)   


If I HAD to choose between the two and I thought they were being straight with me, I would choose the situation where the experienced guy is the principal surgeon and the assistant is the one who is less experienced.  No way would I let the inexperienced guy be the principal. 

However, when I was looking at robotic surgery as an option, the experienced practioners I was considering had a partner (NOT a resident) as the assistant.  That is, BOTH surgeons that participated in the procedure had hundreds of procedures under their belt.  I try to give advice on this forum as if I was choosing something for, I would personally find a practice where ANY physician participating in my procedure had hundreds of surgeries completed.  Teaching hosptals are great...I just don't want anyone learning on me unless they are just watching...Just my take...


Age 62
Gleason 4 +3 = 7
PSA 4.2
2 of 16 cores cancerous
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 5/1/09.

Regular Member

Date Joined Apr 2009
Total Posts : 133
   Posted 4/28/2009 7:58 PM (GMT -6)   
When you sign the consent form you can write in terms that are important, for example "only Dr. Smith to perform nerve sparing procedure" and let them know that this is important to you.
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who ishelping me through every stage of this war.
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare but review of literature says ~1.3 %; family says "miracle."
Now working w/ post-surgery issues....

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 4/28/2009 9:22 PM (GMT -6)   
My dad had a resident that did assist on his procedure. I hope not too much of the actual procedure, but after the surgeon informed my mother and I that my dad was out of surgery and that things went well, the resident is the one that came by the room later in the evening to check on my dad and ordered meds etc. All the follow up appts and everything like that were with the surgeon. The catch with going with the large teaching hospitals, is that there are going to be residents. It is definitely a personal decision, that only you can make. Best wishes!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 4/28/2009 9:25 PM (GMT -6)   
With my open surgery, my urologist-surgeon was the lead surgeon, and his back up, and I was told was required by law, was his partner, who happened to be the only surgeon at the time to do robotic, which I didn't have. I would insist on going with the senior level experience surgeon to do the primary work, robotic or open. You got one shot to do this right, and you need the best you have resources and access too.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 4/28/2009 9:34 PM (GMT -6)   
The thing about robotics is there can only be one primary surgeon. There's only one set of controls... tongue Those controls are the only ones inside the body doing the removal...There's several videos on youtube showing a RRP from beginning to end, in case anyone wants to see the whole deal...
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

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