Who gets the first 200?

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Regular Member

Date Joined Jul 2009
Total Posts : 137
   Posted 2/16/2010 8:37 AM (GMT -6)   
It is often said that a robotic surgeon needs at least 200 procedures under his belt to be adequately proficient in doing robotic radical prostatectomies. I wonder how and under what circumstances does this first 200 happen? idea
70 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0. Doubled from 3.5 to 7.0 in one year.
Neg. CT and Bone Scan
4 of 8 biopsies positive (all right side) Gleason Score 3+4=7
Robotic assisted total prostatectomy and node excision July 2009 in Luzern, Switzerland by Dr. A. Mattei in the Kantonsspital. New Gleason was 4+4=8
pT2c G3 pN0 (0/14 nodes +, Margins, etc. clear
Catheter out in 5 days (home in 3 days). No incontinence
Positional neurpraxia in hip and knee resolved 90+% in 5 months.
Potency: beginning tumescence??? at 3 weeks post-op. Still happens at 3 months PO. Nearly usable one month later. At 5 mo. with 100 mg Vitamin V, pretty good. Now beginning 5 mg Cialis daily.
3month PSA less than 0.01, 6 month PSA less than 0.01

Regular Member

Date Joined Aug 2009
Total Posts : 374
   Posted 2/16/2010 9:21 AM (GMT -6)   

Hey Brain..........I've often thought about that as well. Everybody has to start somewhere. I think one contributing factor to being one of a particular surgeon's first 200 may have to do with insurance parameters. For instance, I have a friend who preceded me in robotic surgery. He wanted to have it done by Dr. Lee at HUP in Phila., like I did, but his insurance was about to end, he couldn't get an appt with Lee in time, so he went with the local uro, with whom I am also following. He had only done about 30 at that point. Also, specific plans may not allow for out-of-state coverage, thus limiting choices. My buddy, thank goodness, is doing fine. One & half years out---PSA undetectable, no incontinence issues, and working on ED like the rest of us..........it may have helped that our local uro trained with Lee at HUP--------travel and locale may also contribute to a choice of a surgeon who has not arrvied at the 200 level yet.

Arnie in DE


Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, NO MX, Prostate 61.8 grams, gland involvement 2-10%
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point......ED at 10 months continues to improve, albeit slowly. Continued daily use of 100mg Viagra (ADC). Discontinued pump use; manual stimulation to varying states of erections; achieved penetratable erection on a couple of occasions
3 month PSA--<0.1
6 month PSA--<0.1
10 month PSA--<0.1

Veteran Member

Date Joined Nov 2008
Total Posts : 697
   Posted 2/16/2010 10:49 AM (GMT -6)   
I was one. (It's not necessary to shower me with gifts and accolades, but if you insist....)


Dr: There's this new technology, Da Vinci, where we use a robot...
Me: How many of these have you done?
Dr: None, but I have assisted in some. Don't worry, there will be experienced eyes and hands in the OR with me, including a very experienced Da Vinci surgeon. Plus, I'll be training on models and cadavers before I work on you.
Me: Okay!

Well, it wasn't quite that simple, but it went something like that.

For every guy who shows up here and asks questions, who picks up books on prostate cancer, who wants to investigate all options, I'm guessing there are 3 who just want to go along with the first suggestion the doctor makes. That wasn't exactly me--but those kind of men are the ones who probably make up the bulk of the 200 (or whatever number).

In my case, my inherent geekiness contributed to me jumping for the robot. I got to try out a demo model of the machine a few weeks before surgery. That was cool.

I came out with positive margins and a PSA that started rising 6 months after surgery. Maybe it was because of the learning curve. Who knows? You can get results like that from a very skilled robotic surgeon as well. My gut (ha!) tells me that the "guinea pig" aspect of my surgery did have something to do with my outcome. I'll always wonder.

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/16/2010 10:52 AM (GMT -6)   

I had open surgery with a skilled surgeon with 30 years experience, and still had a positive margin and recurrance within 9 months of surgery. I do not blame the surgery or my surgeon for this.

David in SC
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days

Regular Member

Date Joined Sep 2009
Total Posts : 464
   Posted 2/17/2010 8:58 AM (GMT -6)   

My sister-in-law is a recovery room nurse in a hospital that just received a Da Vinci last year where one of the local Uros took a training course and is now preforming robotic prostate surgeries.  Currently he has done about 75 surgeries,  and does about one a week on average.   

I asked my sister-in-law the same question as you, "what men would take a chance having surgery with a surgeon who has absolutely no experience doing this kind of delicate procedure, all knowing what the possible side effects can be ?"  Well, she told me that the majority of the men that he does surgery on so far, they seem to be older, lower income,  medicare guys that don't seem to have the financial options to be able to travel and interview surgeons.   She also said that a lot of the men just seem to be not very educated in doing research about doctors, and they just accept everything the doctor says without question simply  because he is a doctor,  therefore he must be all knowing and know what he is talking about.

She did tell me about a couple of horror stories about this surgeon's  learning experiences.  During one of his first surgeries, he accidently put a cut in the intestine of some poor guy and they had to do a second surgery to repair the tear.  In another surgery he screwed up  sewing the ureatha  to the bladder and had to operate again to repair that.

I guess everyone has to learn , but I am sure glad that I did my reaserch and I had the financial ability to pick the surgeon I wanted. 


Age 56, Biopsy 6/2007 - PSA 4.5, 2 of 12 with  <5% cancer Gleason 6
Surgery 9/2007 Strong Memorial,  Rochester  NY with Dr. Jean Joseph (1300 plus surgeries)
 Path - Negative margins, cancer in 20% examined tissue, Gleason 6
 Post Op - No ED issues, full erections without drugs,  used 5-7 pads a day for 3 months. Now dry except for stress leaks now and then.
 All post op psa's <.04

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 2/17/2010 11:40 AM (GMT -6)   
NY- interesting and about what I figured....thanks You know, we guys here who are llokign at alternative are- sadly- minority of PCa patients. Our age group and older have been trained all our lives to accept the god/doctor premise and to follow medical care as told, so the big majority of guys never even begin to get to our stage of looking and questioning. I have several friends who have been diagnosed with PCa and they have just went along with what their uro suggests, usually after asking :"if it were you or your Dad, what would you do, doc?" Mos of them are 'medically lazy"- also, looking for an depending on the easiest way out of their diagnosis.
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 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN

Regular Member

Date Joined Dec 2009
Total Posts : 97
   Posted 2/17/2010 3:04 PM (GMT -6)   
Remember it requires 2 surgeon to do Da Vince surgery. My uro who has done almost 1000 RRPs said that another surgeon would be relieving him during surgery from time to time. I guess that is the way new surgeons get their experience.

Age 70

PSA 5/2008- 3.6, PSA 7/2009- 6.1, retested 9/2009-5.1.
Biopsy 9/2009. 4 of 12 positive. Gleason 3+4=7
CT and bone scan negative.
Robotic De Vince Surgery 10/29/2009. 1 night in hospital. No pain. Cath out on 11/6
Pathology Report: Gleason score 3+4. Margins slightly involved <.1mm to .25mm. Perineural invasion present, stage pT2c. Tumor 18%. Seminal Vesicle - absent, Lymph Nodes 0 of 6.
Continence- first 4 weeks after cath out Dry at night, rest of time, bladder held nothing. 6-7 pads per day. as of 12/30 no pads most of time. almost dry except for a few drips. I keep doing Kegels.
ED. Started VED on 12/17. 15 min every other day. 20mm cilias twice a week. No sign of life yet.

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 2/17/2010 3:22 PM (GMT -6)   
This kind of thing can happen in other treatments like brachy seed radiation, alot money being made in the name of PCa and medical help on anything. Don Cooley pointed out a case whereby a 'newbie' trained doctor had just learned about brachy seeds and put his Sign-shingle on the building type of thing and went into that business, as he was losing customers from surgery (the story is told). Well among one of his first patients, a guy gets a brachy seed implanted into a seminal vessical and not the prostate itself and caused problems and needed correction.
Wonder what the refund was? (lol)

How about the guy that posted on here over a year ago, had robotic surgery by apparently a 'newbie-expert', whom did not even get all the prostate gland removed and tried to cover it up by shipping him directly to a radiation doc friend as 'recurrance' issue. He later found by ultrasound or such that part of gland was not even removed....this is good work (LOL). He is trying to sue he said and I hope he wins big, get a jury envolved. Welcome to the jungle!!!(as Axle Rose sings out with Guns 'n' Roses) Hey $25K or more for 4 hrs. work approx., and line up a few a week and life is wonderful if you worship money.
Youth is wasted on the Young-(W.C. Fields)

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/17/2010 4:14 PM (GMT -6)   
yeah, zufus

that brother was here for a while with that terrible story, the great cover up of a blotched robotic surgery. he lives right here in sc, i believe it was in florence in the other side of the state. i was in touch with him for a while, but he suddenly withdrew. he had about a raw a deal as i have ever heard about. malpractice lawyers were probably lined up outside his house. all kidding aside, i hope he is ok.
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 2/17/2010 9:10 PM (GMT -6)   
I go to a fairly large URO practice here in Ohio which has 10 or 12 docs. I go to one of the younger guys who is a really terrific guy who I use for general follow-up.

When I had my surgery, I asked how many the most senior surgeon had done, and they said about 150. My URO had done 5 at that time. I asked him the other day how many he had under his belt, and he said about 25, ( about 20 more in 9 months)

I would imagine in the smaller ciites ( ours about 350,000 msa), it is hard for a surgieon to get the experience he needs. So , as is suggested, it is the guys who have not educated themselves, or the medicare guys who take what they can get.

I drove 2 hours to find a guy with 800.
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01

Regular Member

Date Joined May 2009
Total Posts : 121
   Posted 2/17/2010 9:16 PM (GMT -6)   
I asked my dr the same question becasue he was one of the first using the robot. He said it was typically a guy who was interested in science type things and had done research. Not for me, I am in the construction business, #1 rule is let someone else try the new stuff and figure out the problems
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.

Veteran Member

Date Joined Apr 2008
Total Posts : 1132
   Posted 2/17/2010 9:17 PM (GMT -6)   
My doc had only done 50 and so I recovered nicely. I thought my doctor was qualified and never looked back. When I was talking to an oncologist, I said who is patient #1. He said, people are standing in line at state hospitals for help. he got a lot of experience at state hospitals helping the ones that couldn't afford medical care.
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
20 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better

Veteran Member

Date Joined Nov 2006
Total Posts : 883
   Posted 2/19/2010 5:25 PM (GMT -6)   
    You may want to think about this one too!  If you go to a "teaching" University Medical Center the Doctor you book with may not be the one that actually does most of the surgery.  The "teacher" will be right there to assist and watch over the operation.
    Just a thought!
    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
     Dec. 2006 – Oct. 2008 Cystoscope, Two Collagen injections,Second Opinion   
    Consultation for Incontinance at OU Medical Center, Bio-Feedback       
    training, Chiropractic, Accupuncture , AdVance Male Sling, Two More Collagen 
    injections, AUS Installed and Activated (Dr. Morey at UT Southwestern Dallas TX)
    All to try to resolve incontinence (using 6-8 Depends Guards a day)

    To Date All PSA's 0.00.



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