Robotic Surgery Is Questioned in New Study

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Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 10/14/2009 6:30 AM (GMT -6)   
Hi Guys:
 
This will undoubtedly add to the debate of open vs. robotic.  According to this study, there were more long term urinary and sexual problems with laparoscopic/robotic surgery than with open. 
 
There clearly may have been some reasons why...including lack of experience by the robotic doctors.  Anyway, read for yourself and decide.
 
Tudpock
 
http://news.yahoo.com/s/ap/20091013/ap_on_he_me/us_med_prostate_surgery


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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!
Tudpock's Brachytherapy Journey: http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Post Edited (Tudpock18) : 10/14/2009 4:45:44 PM (GMT-6)


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 10/14/2009 6:49 AM (GMT -6)   
I had traditional surgery so my dog isn't in this particular fight but it appears to me that what it really is saying is that practice counts.
The more surgery the doctor performs the better he gets at it and the better the outcome for the patient. Even the RDS doctor they quoted said
he took 700 surgeries before he got really good. I'd have hated to be #250 even though that sounds like a lot.
My doc had done over 2000 traditional surgeries. It simply means having a robot doesn't make you have better hands.
Diagnosed at 54
PSA 8.7
Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7
Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09
Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence
Pad free week 5
PSA 6/6/09 <0.1
PSA 9/10/09 <0.1


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 10/14/2009 6:52 AM (GMT -6)   

Same discussion here:

http://www.healingwell.com/community/default.aspx?f=35&m=1614361


Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 10/14/2009 7:10 AM (GMT -6)   
Tudpock,

Good article and YEP you are right on the money, this will certainly fuel the debate for the next few months in all the journals associated with PCa and treatments.

We are just a small sampling here at HW and yet the results of every aspect of treatment, surgery in whichever form, rad, chemo and so on are different on every level.

I don't think anyone will ever find that there is one clear cut definitive answer for PCa treatment and quality of life issues.

When you look at the studied universe of 9000 from Medicare patients info, there is an entire world left out. Medicare suggests that all of the patients studied were 65 or over. How many 10s of thousands were left out of the study because they were under 65 and had private health insurance?

Every major hospital and Urology Institute in the country probably has almost as many patient follow-up as this study has. My dr has patient study info on 4500 da Vinci surgeries alone. I can only imagine that JH, Sloan Kettering, Cleveland and so on have similar numbers.

It is studies like this that only serve to muddy the waters not just with PCa, but with just about ever other medical disease and treatment as well.

My wife and I found this to be true with her cancer, Multiple Myeloma. Every one had their preferred method of dealing with it as well.

Bottom line is just the same as that which is stated time and again here at HW. You do your research, ask your questions, sift through the answers and make a decision on what you feel is best for you and you alone.

What a crap shoot.

Of course like everything else in life, this is just one man's opinion.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


webstergl
Regular Member


Date Joined Mar 2009
Total Posts : 25
   Posted 10/14/2009 1:38 PM (GMT -6)   
I would have to believe that men in there 40's and 50's would have a large bearing on this study I spent a lot of time with my doctor discussing the open and robotic nad he gave some pretty solid statistics for men in my age group comparing both pretty much there was slight differences I elected robotic mostly for the shorter recovery time I was also told that since I am a thin person by nature that it made me a better candidate for robotic. I did have some post surgery complications due to a hematoma that developed but that can happen in any type surgery and it thankfully resolved itself and caused a condition call Illeis (not sure if that is spelled correct) it is a condition where the bowels shutdown and go flat and I had to have a blood transfusion ended up in the hospital for 8 days but I have to say that prior to my surgery talking with 2 different doctors they both told me that these conditions can happen and with either type of surgery, I was just one of the lucky few that it did happen to.

I believe that either way is affective treatment option, the study to me looks a bit lopsided it needs to be spread out to cover all age groups to really have any valuable statistics to go from.

Just my thoughts
Age 54 (Dx age 52)
11/06 severe prostate infection PSA was at 52
2/07 PSA still at 6.2
3/07 Biopsy
4/07 5 of 12 core samples positive with Gleason at 6 -7
6/07 Robotic Radical Prostatectomy
Pathology showed Cancer was organ contained
Last 4 PSA’s 0
11/08 Dx with BNC (Bladder Neck Contracture) due to scare tissue
3/08 balloon dilation
8/09 AUS implant now waiting 6 weeks for activation
10/12 AUS was activated life has gotten much better


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/14/2009 2:57 PM (GMT -6)   
Slammed might be quite strong. When you read the article it definitely states that surgeons with more experience have much better success. I believe that this was not a surprise. Anyone looking into DaVinci robotic surgery should definitely look into the physician experience. 1 to 200 is not enough. There is excellent success when the surgeon has over a thousand procedures...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/14/2009 3:02 PM (GMT -6)   
n addition,
The study lumped LARP with RALP patients and that just does not give a clear picture. There is a huge difference between LARP and RALP. The study clearly does not single out robotic procedures.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 10/14/2009 3:26 PM (GMT -6)   
Not sure what comments lead one to believe Robotic gets "Slammed" would be a conclusion to the article especially after this comment

"The data did not indicate how many of the less invasive cases involved robotics." It could have been less than 1%, it could have been 1 or 2 cases

A very ominous potential list of open surgery problems mentioned

"They also had lower rates of blood transfusions, breathing problems and internal scarring."

A lot of issues can arise from blood transfusions which would be a separate statistical addition to the findings. The same would hold true for breathing problems and scar tissue formation. None of the three is a problem with Robotic surgery

Yet another statistic that is missing is the duration of the surgery, my understanding is the open surgery is a lot longer procedure. My robotic was 1.5 hrs, thats a lot less time under anesthesia and the dangers associated with being under 3 times longer

The stats only point to Incontinence and ED
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2301
   Posted 10/14/2009 3:51 PM (GMT -6)   
My take is that this is a very flawed study with a lot of statistical noise rather than valid conclusions. 
 
One thing seems clear from the shift to the use of daVinci robotic vs. open prostatectomy, the manufacturer of the daVinci did a whale of a job  convincing physicians and the public of the superiority of this technology.  Whether it is better (independent of the surgeon's expertise) remains an open question.  


PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE negative  1 of 12 biopsies positive (< 5%) 
Open surgery June 2006 at age 57
Organ-confined to one small area, Gleason 5   
PSA's undetectable  < 0.1  

Post Edited (TimG) : 10/14/2009 3:54:09 PM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 10/14/2009 3:52 PM (GMT -6)   
Tud****,
 
It seems like you must have read the headlines without actually reading the article...
 
I don't see any "debate of open vs. robotic."  The article says to hire an experienced surgeon, and that during the years of the study there were a lot of surgeons learning on the robot.
 
Mass media likes to generate naive, gasping responses like yours, and (as an unfortunate result) their style of writing articles geared to the least common denominator of audiences who don't actually read the entire article.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 10/14/2009 3:58 PM (GMT -6)   
I think Tim has an excellent point. One of my doctors, a surgeon, said that he had to learn Robotic because many of his patients were demanding it, not because he thought it was any better. I think Marketing has much more affect on our treatment optons than any of us would like to believe.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 677
   Posted 10/14/2009 4:11 PM (GMT -6)   
TC-LasVegas said...
Slammed might be quite strong. When you read the article it definitely states that surgeons with more experience have much better success. I believe that this was not a surprise. Anyone looking into DaVinci robotic surgery should definitely look into the physician experience. 1 to 200 is not enough. There is excellent success when the surgeon has over a thousand procedures...

Tony
Tony
 We all generally agree that an experienced surgeon is important to a good outcome.  As I said in another post on this subject, the author showed no data that I know of that in any way rated the ability or experience of the surgeon.  Dr Wu then went on to say that  experience was very important.  He is entitled to his opinion, just like you and me.  However he was irresponsible to draw this conclusion without supporting data from their very badly documented study.
 
It makes me angry when the media picks up a story like this that will influence thousands of people, when the data is not good.  While I agree with much of what they say, they just used Medicare treatment numbers to assume their "facts". That and the fact that they did not separate robotic from non robotic laproscopic surgery, makes their study worthless.

http://jama.ama-assn.org/cgi/content/short/302/14/1557?home

I was only able to read the abstract as I do not have a JAMA subscription


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

Post Edited (lifeguyd) : 10/14/2009 4:28:10 PM (GMT-6)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 10/14/2009 4:19 PM (GMT -6)   
Might be an interesting unscientific poll here on HW.

Who had robotic, and who had open, and is there any perceivable difference in side effects .
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
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)
5 month PSA <.03 (undetectable)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 10/14/2009 4:53 PM (GMT -6)   

Sorry if I offended any delicate sensibilities by my Forum Topic; I have changed it to what some will find to be more politically correct.

I did not mean to make any value judgements about "keyhole" surgery, rather was attempting to share some information

And, Casey, assuming you stick around for a little while, you will learn that I do indeed read a lot of studies, including any that I post for information.  This article stated:

 " new study suggests less-invasive keyhole surgery for prostate cancer may mean a higher risk for lasting incontinence and impotence when compared with traditional surgery."

That IS a criticism of "keyhole surgery"...not my criticism, but that of the article.
 
I think some of you guys need to chill out a bit and understand that sharing of info, even controversial info is ok... rather than being concerned about a little hyperbole in a headline...but, again, that's just MHO. 
 
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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!
Tudpock's Brachytherapy Journey: http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Post Edited (Tudpock18) : 10/14/2009 5:50:22 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/14/2009 5:13 PM (GMT -6)   
I agree with the study in part, but again emphasize it is a bad study. I believe that many performing the DaVinci surgery are doing so by demand and that is indeed resulting in higher incidence of complications. This is a very valid point. As Lifeguyd says, we always place surgeon experience ahead of modality in making recommendations here. I know here in Vegas they added two Da Vinci systems recently, and you know what? I would not use those centers. The top doctor in Las Vegas has less than 100 RP's using that system. The doctor I chose had over 1500. My plumbing works well. And as of today I am approaching year 3 with a stage 3B cancer in remission.

I spoke with Mike Scott about this today during an interview I was in about Provenge, and he mentioned that it is very similar to a Brachytherapy doctor with limited surgical implantations and that with time the statistics improve.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/14/2009 5:19 PM (GMT -6)   
Sure glad I didn't have to be someone's learning curve with my surgery.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 10/14/2009 5:35 PM (GMT -6)   

Tud****,

 

Maybe you didn’t read what I wrote, either; specifically the part about “…during the years of the study there were a lot of surgeons learning on the robot.”

 

The study ran in the early- to mid-2000’s when most all doctors were coming up the robotic learning curve.  Most urology surgeons training during this time were training on the robot, while the older, more experienced docs were still mostly doing open surgeries.  (Of course, those learning the robot were also simultaneously doing, or learning—in the case of young docs—open technique.)  Almost nobody had vast experience on the robot; almost everyone during this time was coming up the learning curve.

 

So this study compared the results of older, experienced docs doing open to everyone new who was getting started on the newly available robotic systems. 

 

The article was probably written by some noob journalism major who graduated last semester who and never spelled “prostate” before last week, but likes to throw around the word “Slammed” just to get attention for his amateur work.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 10/14/2009 5:45 PM (GMT -6)   

Casey...dude...don't shoot the messenger.  Again, I was not personally making any value judgements about the "keyhole" surgery based on this article...I was just sharing it.  Personally I think the study is flawed work, but that does not mean it is not worth sharing with our brother survivors on this site.

Also, FYI, to gain any cred you might want to consider posting your stats after your signature like most of us do on this site.

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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/14/2009 5:48 PM (GMT -6)   
Casey,
Tudpock has not been harsh with his remarks and his post is relevant to this website. Constructive criticism is best directed to the writers not the readers. This is being discussed by the various groups and I am certain that this study falls short of useful data moving forward. The one exception is that anyone choosing surgery, should place the surgeon experience as the top criteria when selecting him. The same can be said for Brachytherapy, cryotherapy, HIFU, and virtually any person you would have work on you.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 10/14/2009 6:09 PM (GMT -6)   
Don't be so easily influenced, in knee-jerk fashion, to respond to a brief article about a study that should be carefully read - including the fine print- before coming to a judgement.  What I get out of the article is that the study was designed by researchers to slant the findings in a false and misleading way.  Bulls*it - full of bullcrap and such games do damage to the seriously interested researchers - and we patients.

Age:  60 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0

 


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 10/14/2009 6:17 PM (GMT -6)   

Hey Tud,

My comment wasn't intended to be a "shoot the messenger" as much as it was about "missed the message" of the article.  The message that guys visiting this board should take-away is about getting an experienced surgeon.  Unfortunately, the media-trap headlines misguides and alarms guys and does a dis-service when the interpretation shifts focus on a meaningless comparison of learning curve robotic results vs. experienced open results.  The article's author is a noob for setting this trap.  A credible interpretation of the article goes beyond the surface/headline.

By the way, is there really a "debate" on open vs. robotic??  A debate among whom?


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 10/14/2009 6:29 PM (GMT -6)   

Casey...I still think you missed the message re my posting this at all.  I was not intending to dissect the article or the study or make any value judgements about it.  If you stick around and read my posts you will see there is no equivocation when I am stating an opinion or making a value judgement.  I was simply sharing...period...that's all and that simple...period...

And, yes, there certainly is debate about robotic vs. open...most surgery survivors on this site have opinions on that subject as do many physicians.  Why would you think there is not any debate?

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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 10/14/2009 8:09 PM (GMT -6)   

Q:  Why should there be no "debate" between open and robotic surgery...?

A:  The main point that readers should have taken away from the article was that open and robotic surgeries in the hands of an experienced surgeon yield essentially the same results.

This is about the ten-thousandth time this has been said.  Dr Peter Scardino, chief of surgery at MSK made this comment about the study:  "At the end of the day, what all the studies will show is that it's not the tools the doctor uses, but the experience and skill of the surgeon."  Are people really still debating this??

later...


clrwtr
New Member


Date Joined Oct 2009
Total Posts : 2
   Posted 10/14/2009 8:14 PM (GMT -6)   
One of my neighbors relatives is one of the design engineers on the DiVinci robot. When I was diagnosed a couple of months ago he quickly put me in contact with him and shared the info given to him when he was diagnosed almost 2 years ago. The bottom line is that he was told that given his experience working with Drs developing and improving the DiVinci if HE were looking for a surgeon he would not even consider anyone with less than 1,000 surgeries and the more the better. He likened it to playing video games, it is Totally different than open surgery and the skills are difficult to learn. If you look at the statistics for Drs like Menon and Patel who have thousands of surgeries each (Patel has over 3,000 at this point) their stats are great. If you talk to them they will tell you that because of their reputation they get some of the most difficult cases which actually lower their stats. The problem is that all the Drs that are learning and may never get the "hang" of it are included in the study. I am having Patel do my surgery November 6 and have great faith. If I could not have him or Menon, Tewari or someone with similar experience I would consider radiation.

RHC Jr.
Regular Member


Date Joined Feb 2009
Total Posts : 39
   Posted 10/14/2009 9:16 PM (GMT -6)   
Tudpock:
 
Notwithstanding the comments of Casey (who fails to provide any info on his PCa), clearly there is a debate with respect to robotic vs. open.  Just look at this forum.  Every month someone asks for guidance or info on that topic.
 
As to the study, I am thrilled that some researcher has paid attention to PCa, and has devoted time and a serious publication to one small aspect of the treatment.  Is the study bad?  Or, is it merely incomplete (according to some posters here, (a) the universe studied was not sufficiently large, (b) the data is skewed toward men 65 and older, (c) the study fails to differentiate between robotic vs. other laproscopic procedures, and (d) the study doesn't consider other important factors, such as less blood loss and reduced operating time).  But, aren't most initial studies incomplete.  Isn't that the nature of research, in that one study serves as a basis for further studies to correct the "flaws" or to examine the unexplored areas.
 
For most of us here, our situations are set.  We already have chosen one form of treatment over another.  But, don't we all want better data and info for those who follow us on this PCa journey?
 
BTW, for anyone who suggests that the experience of the surgeon, as measured by the numbers of procedures performed, is the only valuable info to be taken from this study, I note the following.  I had my daVinci procedure done by a surgeon who had performed 500 such operations.  Yet, 11 mos. later, I am totally incontinent and have ED.  Was it the surgeon, was it the procedure, or was it just me?  Studies on this topic may advance the info for those who follow.
 
RHC Jr.
Last PSA prior to biopsy  -  11.9
Biopsy  -  8/7/2008
Cancer findings at left lateral and left medial apex of prostate
Gleason score  -  3+3 = 6
Staging  -  T1c
Prostate size/weight  -  128 cc./ 99 grams
Bone and CT scans  -  9/12/2008  -  both clear
Age at biopsy  -  65         Health  -  Excellent (other PCa)  (Lift weights, play golf & tennis (incl. singles))
da Vinci RP surgery  -  12/15/2008 at Naples Hosp.
Surgeon  -  Dr. Wm. Figlesthaler
Hosp. Stay  -  1 night
Catheter removed  -  12/23/2008
Post-Op blood tests  -  2/2/2009, 3/27/2009,  5/7/2009 & 8/12/2009          PSA  -  undetectable
Completed 12 weeks biofeedback, coupled with electrical stimulation  
 

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