Open vs Robotic surgery

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Squirm
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Date Joined Sep 2008
Total Posts : 744
   Posted 7/24/2009 3:26 PM (GMT -6)   
Is there credibility to this claim of open Vs Robotic surgery?
 

huey
Regular Member


Date Joined Jul 2009
Total Posts : 27
   Posted 7/24/2009 4:36 PM (GMT -6)   
Squim,

Good question.

It sounds too good to be true but I guess each case is different.
I live in the Detroit area and I'm newly diagnosed and have been thinking about robotic surgery at Henry Ford Hospital.

If anyone has had this surgery at Henry Ford by Dr Menon and his team please let us know the results.


thanks

Huey
Age: 64
Dx: 6/2/09, Age 63
G: 3+3
PSA: 2.04
Samples: 12, 1PC, 20%
DRE:positive
Stage: t2a
Still trying to decide on treatment.


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 7/24/2009 5:03 PM (GMT -6)   
I will still say...regardless of the treatment method, outcomes depend upon the skill of the surgeon, therefore experience is the key. However with the survey shown above, without more detail to the type of patients and details it would be impossible to compare open surgery from years ago with todays robotic.
You are beating back cancer, so hold your head up with dignity
 
Les
 
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


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 7/24/2009 6:25 PM (GMT -6)   
Squirm said...
Is there credibility to this claim of open Vs Robotic surgery?
 
   I am always suspicious of anyone who blows their own horn so loudly.  That being said, many of the claims for DaVinci surgery vs open surgery are true.  Be sure to compare "best in class" rather Ford's numbers. I don't know if they lack open skills or skewed the results. The skill of the surgeon is still the best indicator regardless of the procedure.
 
I plain do not believe the "potency figures".  Other studies show a much higher instance of impotence during the first year.  I am also assuming that their patients are using pills and injections.  That was not noted.
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 7/24/2009 7:09 PM (GMT -6)   

lifeguyd:

I'm sure they are fine doctors but your comment reminds me of my own surgeon. When I had my first consultation with him I was asking about some of the claims I was reading on the internet. His reply was they are marketing tools. He doesn't feel the need to 'market' on the web and lets his results and patients speak for him. When I told him of one site I saw with some name such as the international prostate cancer institute he just laughed and said hmmm I think I'll change the name of my practice to the Intergalactic Prostate Cancer institute.

 Larry


Age at diagnosis 54, PSA 6.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/24/2009 7:15 PM (GMT -6)   
While Henry Ford Hospital has a pretty respectable reputation, I would wait for them to publish these results in a refereed journal (don't hold your breath)
This sort of thing is what is called "puffery" selecting only those ways of looking at the date that make you look good.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/24/2009 7:31 PM (GMT -6)   
Talk about tooting your own horn. That was one of the most boastful aggerating comparisom I have ever seen between open and robotic surgery. Are they willing to put into a written guarantee or no charge for your surgery on those ridiculous claims of potency, etc. after their miracle surgery? Of course not. Reminded me of some cheesy local car dealer claiming all kinds of things. Hate seeing things like this out there to mislead our brothers with cancer.

Even though I was open surgery, I have no problem with robotic as a viable option with some distinct advantages, but it still comes down to the actual real time skill and sucess rate of the individual surgeon at hand.

david in sc
Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
 
 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 7/24/2009 8:18 PM (GMT -6)   
I am sure there are advantages to both open and robotic. I will say with confidence that both have proven track records so for me I to think the skill of the surgeon and your comfort with the surgeon outweighs whether one is better than the other. I personally could have gone to Vanderbilt to have robotic but I felt so much comfort with my local surgeon that I chose to have open surgery and I have no regrets.
After reading David's remarks about how boastful the link was I chose not to watch it because I trust his opinions so much.

peace to all
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 7/24/2009 8:36 PM (GMT -6)   
This looks like a sales pitch to me too. One of the claims is true. Less blood loss for sure, because they pump you up with CO2, and the pressure stops you from bleeding so much. One of other claims may be true -- a better chance of sparing the nerves, perhaps because the surgeon can see them better?

But I would debate the other claims. I had open surgery and felt that my recovery was comparable to those here who had robotic. I don't think there is much to choose between the two types of surgery -- anyone contemplating it should go with whatever type his chosen surgeon recommends.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
ED:
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 7/24/2009 10:25 PM (GMT -6)   
I tend to agree with the marketing hype stuff, but in my case case I don't believe the surgeon could have done with open what mibe did with DaVinci. To have an EPE and end with negative margins is mainly because he could look at the tissue with 10X magnification, and scrape away the cancerous stuff.

Any open surgeon would have just whacked both nerves and got out of there.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/24/2009 10:35 PM (GMT -6)   
Hi Squirm,

My surgeon uses the robotic surgery for a few reasons, including less loss of blood, shorter recovery time, and the close up 3-D view during the entire operation.

However, she believes robotic surgery has yet to be proven proven any more effective for cure rate and for ensuring the return of sexual function compared to open surgery.

I believe that robotic surgery is a consideration more for patients in the early stages of prostate cancer, but everyone is different.

I also believe that in the care of an experienced surgeon, one would do well with either surgical method.

Kind regards,

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


Bob D
Regular Member


Date Joined Mar 2008
Total Posts : 199
   Posted 7/24/2009 11:18 PM (GMT -6)   
I had what some may call the "old school" open surgery. While not always the case it
worked well for me as the below info details. I do believe skill plays a bigger part than the
tools. I have seen a skilled woodworker build furniture with hand tools better than some others
with the latest fancy woodworking power tools.
    1. Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. Open Surgery. Northeast Georgia Medical Center, Gainesville Ga. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op and have been improving well since then. Full erection now possible (less than four months post op) with the assistance of Cialis.  Post Op Biopsy : No malignant cells in lymph node. Gleason 3=4=7. Tumor on both lobes. Urethral margins/apex free of neoplasia. Right and left seminal vesicles free of neoplasia. No invasion of prostatic capsule of the resection margins are noted by the tumor. Tumor occupies 10 to15% of the prostate gland. Path staging T2c, NO, MX- Group staging II.  Focal areas of perineural invasion by tumor are noted. 80% natural erections and full erections with 10mg Cialis. 9/22/08-Took 10mg Cialis on Monday night, had very usable full hard erection at night, the next morning, and the following Thursday morning, 60 hours after original dose !! Orgasm quality Excellent.!!!!! I am pleased with the progress so far. Married to same wonderful woman for 39 years. She is still beautiful and sexy as ever. A great help in my recovery !!: 3/12/09: Full natural erections with penetration. 10mg Cialis makes them easier to maintain but I have had several med free full erections lately, Yipieeee !!!!!!!  3/24/09: One year PSA <0.1.  3/28 & 3/29: had sex with full naturals with no meds. Erections are gained and maintained with very little manipulation. Getting more like pre op every day. 5/30/09, I take only 5mg Cialis every 2 or 3 days. This greatly assists my full naturals and provides great staying power and no manipulation required and allows sex anytime !! Lenght and girth are back to pre op size due to regular "workouts".
    1.  


      goodlife
      Veteran Member


      Date Joined May 2009
      Total Posts : 2692
         Posted 7/25/2009 2:07 PM (GMT -6)   
      Bob D

      I was with you until you started talking about hand tools and power tools, and prostate. Makes me feel a little uncomfortable thinking about combining the 2 topics !
      Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
      Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
      0/23 lymph nodes involved  pT3a NO MX
      Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
      Neg Margins, bladder neck negative
      Living the Good Life, cancer free  6 week PSA  <.03
      3 month PSA <.01 (different lab)


      Purgatory
      Elite Member


      Date Joined Oct 2008
      Total Posts : 25393
         Posted 7/25/2009 3:18 PM (GMT -6)   
      Yeah after having my penis "dialated" with metal rods this week, the whole subject of hand tools vs. machinery is a bit sore for me, lol. He might has well used a cordless drill on me, couldn't have hurt less.
      Age 57, 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
       Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
      2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
      Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
       
       


      Bob D
      Regular Member


      Date Joined Mar 2008
      Total Posts : 199
         Posted 7/25/2009 11:31 PM (GMT -6)   
      Just making a comparison, not trying to scare anyone. But yes, if I see him coming at me with a dremel tool and
      a pair of vise grips I am out of there.

      Purgatory
      Elite Member


      Date Joined Oct 2008
      Total Posts : 25393
         Posted 7/26/2009 8:07 AM (GMT -6)   
      My weiner is still in some kind of shock induced coma from last Monday's "procedure", hope the lil fellow will make it again.
      Age 57, 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
       Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
      2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
      Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
       
       


      engineer55
      Regular Member


      Date Joined May 2009
      Total Posts : 121
         Posted 7/26/2009 8:37 PM (GMT -6)   
      I agree with the statement about published results, if they are going to make these kind of pitches it needs to be done first in a journal or presented in a conference or something. To just throw them out there looks a little shakey to me.
      Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
      DREs all negative
      PSA was in the 3-4 range then jumped to 7
      I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
      PSA was cut in half.
      I did Active S for a year but concluded that I didn't want a life
      of biopsies and Uro meetings.
      DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
      Final was 5% one side all clear, but had a huge 90 grm prostate
      Now we work on pee control, ok at night but sitting is a big problem.


      wd40
      Regular Member


      Date Joined Jan 2008
      Total Posts : 218
         Posted 7/27/2009 10:49 AM (GMT -6)   
      I've had both. Dogone if I can tell the difference.:o)
      12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.


      Tudpock18
      Forum Moderator


      Date Joined Sep 2008
      Total Posts : 4274
         Posted 7/27/2009 12:56 PM (GMT -6)   

      Hi Guys:

      In reference to geezer's comment that he wouldn't believe it until and unless this was published in a respected journal, I decided to see if I could find such a publication.  As it turns out, they DID publish results of a fairly extensive study of their robotic results in 2007 in the "Cancer" journal of the American Cancer Society.  Here is the link for those of you want to read it.

      http://www3.interscience.wiley.com/cgi-bin/fulltext/116322982/HTMLSTART

      From my analysis, the info published on their web site does appear to be a bit of puffery if compared to the results of their published study.  Now, it may be that this respected institution has other results that back up their web site stats but, if we use the "geezer criteria" of publication in a respected journal, here is what you get:

      1.  Cure - defined as no detectable PSA at 5 years.  Web site said 97%, journal study said 84%.

      2.  Urinary Function. Web site, defined as no pads needed said 96%. Journal study, defined as less than 1 pad per day said 93%, and said 82% if defined as "no leaks".

      3. Sexual function - defined as erections good enough for penetration.  Web site said 97%, journal study said 79% (with 44% of those using aids to get it up).  In fairness, the web site states that the 97% is with the "Veil of Aphrodite" procedure while the journal study included all robotic procedures done at HF.

      So, using the "geezer criteria", which I think is excellent, the HF results are good...but not as spectacular as their web site promotes.  As usual, the devil is in the detail.

      Perhaps HF will have an upcoming published study that proves their promoted results...in the meantime, it's probably wise to count on what they have pubished under the "geezer criteria".

      Respectfully submitted,

      Tudpock


      Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
      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 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

      geezer99
      Veteran Member


      Date Joined Apr 2009
      Total Posts : 990
         Posted 7/27/2009 1:46 PM (GMT -6)   
      Tud
      Thanks so much for tracking this down and writing it up. I urge people to compare the hospital website with this article. Yes, reading the article takes more effort, but at least when I read it I see a carefulness of expression and a clarity in defining terms that gives me confidence in the people behind the study. Learning about PC also means learning to judge the quality of what you read.

      I suspect that the website’s numbers can all be justified by slicing the data in different ways. The advantage of journal publication is that editors and referees will insist on adherence to accepted statistical practice.
      Age at diagnosis 66, PSA 5.5
      Biopsy 12/08 12 cores, 8 positive
      Gleason 3+4=7
      CAT scan, Bone scan 1/09 both negative.

      Robotic surgery 03/03/09 Catheter Out 03/08/09
      Pathology: Lymph nodes & Seminal vesicles negative
      Margins positive, Capsular penetration extensive Gleason 4+3=7
      6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
      10 weeks: no pad at night -- slight leakage day/1 pad.
      3 mo. PSA 0.0 - now light pads


      Squirm
      Veteran Member


      Date Joined Sep 2008
      Total Posts : 744
         Posted 7/27/2009 2:34 PM (GMT -6)   
      Tud, very interesting and thank you for finding that!

      Purgatory
      Elite Member


      Date Joined Oct 2008
      Total Posts : 25393
         Posted 7/27/2009 3:07 PM (GMT -6)   
      Tud, great detective work, and you proved that once again, HF like many other big name places, toots their own horn with decption in disguise, proving once more, that's its all about the money.

      Great job you did though.

      David in SC
      Age 57, 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
       Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
      2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
      Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
       
       


      geezer99
      Veteran Member


      Date Joined Apr 2009
      Total Posts : 990
         Posted 7/27/2009 3:30 PM (GMT -6)   
      Hey wait guys, this is a study about RRP not HF
      Age at diagnosis 66, PSA 5.5
      Biopsy 12/08 12 cores, 8 positive
      Gleason 3+4=7
      CAT scan, Bone scan 1/09 both negative.

      Robotic surgery 03/03/09 Catheter Out 03/08/09
      Pathology: Lymph nodes & Seminal vesicles negative
      Margins positive, Capsular penetration extensive Gleason 4+3=7
      6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
      10 weeks: no pad at night -- slight leakage day/1 pad.
      3 mo. PSA 0.0 - now light pads


      FiftiesMale
      Regular Member


      Date Joined Mar 2009
      Total Posts : 75
         Posted 7/27/2009 4:35 PM (GMT -6)   
      Interesting article. I, too, am initially skeptical of any institution that would toot its own horn in this fashion, in what appears to be a marketing scheme. It IS possible that the "surgeons" at HF are not responsible for this article/website. It might just be the Public Relations organization at Henry Ford that have put together the website. If the surgeons are involved, or are aware of the boastful nature of H/F, then I am uncomfortable with such in your face claims.

      My surgeon is known around the world, and is considered one of the best in the country - possibly in the world. Yet, you would never hear him, or his institution, or the institution's website make such claims about him. When surgeons, or institutions have good solid reputations, they do not need to toot their own horn, it just somehow gets around that they are the best. Do you think that you would find the same type of article at Johns Hopkins website, or about Dr. Patrick Walsh? Hardly. Yet, Hopkins and Walsh are known around the world for their expertise. (Walsh was not my surgeon, by the way).

      In defense of the surgeons at H/F, I am willing to accept that they are excellent. I would probably feel fine about referring someone there (if my institution and/or surgeon was busy. :-) However, i just don't like a surgeon or an institution that heals people to be arrogant about it. It just doesn't seem right.
      Age: 53
      8/1/2008: PSA 6.2, GP recommended retake.
      8/27/2008: PSA 5.8 (%free 12.1) referred to Urologist.
      9/10/2008: DRE - non palpable. Urologist recommended biopsy
      10/2008 Biopsy appt:
      10/21/2008: Biopsy results; 1 positive out of 10 samples.
      Biopsy Results: Gleason 7 (3+4) , no evidence of perineural invasion.
      Referred to UCSF
      12/19/2008: Transrectal Ultrasound at UCSF
      12/19/2008: Consultation with Surgeon.
      Surgeon concurred on Gleason 7=3+4 (per slides).
      2/24/2009: Robotic Assisted Laparoscopic Prostatectomy (DaVinci) UCSF
      3/5/09: Cathetor removal.
      Post Op Pathology: margins negative/clear, Gleason 4+3=7
      4/8/09: first post-op Ultrasensative PSA: less than 0.01
      Currently taking Viagra, Levitra (tried Cialis).
      Purchased and using Osbon manual pump.

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