Robotic Prostatectomy performed by a resident

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klains
Regular Member


Date Joined Nov 2010
Total Posts : 79
   Posted 12/8/2010 8:38 AM (GMT -6)   
Just wondering if anyone has had a Robotic Prostatectomy performed by a resident, of course overlooked by the director of the urology. ( whom we wanted to begin with) Just found out our insurance ( Thankfully we have some) Will only cover this procedure , done this way through the hospital clinic. Our insurance is not very good, but again thankful we have some.

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 12/8/2010 9:45 AM (GMT -6)   
I think the Dr should have told you before hand. Usually in that case the Main guy observes and does the real delicate issues. The routine stuff is done by the resident till they are proficient.

Cajun jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
Only issue at this time is ED

Jazzman1
Veteran Member


Date Joined Sep 2010
Total Posts : 1160
   Posted 12/8/2010 9:53 AM (GMT -6)   
Some very good teaching hospitals have residents perform critical portions of these procedures routinely.

I had a very frank conversation with my surgeon at the Cleveland Clinic about this before my surgery. He told me that his approach (open surgery) is a four-handed procedure, and that a resident would be providing two of those hands. He assured me that he would be there the whole time, and that everything would be fine.

Despite my apprehension, I went ahead with the surgery and (my lips to God's ears) I think everything went fine. I think if I were in your socks I'd want to know just how many of these procedures the resident has done, but I wouldn't discount the possibility that this could work out fine. I seriously doubt they'd let some resident with zero experience do this procedure solo. I also think the robot takes makes up for inexperience to some degree.

That said, I agree with questionsabout it: this is a crappy policy for an insurance company. Whatever you decide to do, best of luck with your procedure.
Age 55
PSA: 8/09 2.69 -- 7/10 4.00 -- 8/10 4.11
--------------------------------------------------
Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C; Gleason 6
---------------------------------------------------------------
open radical prostatectomy at Cleveland Clinic 11/2/10
Post-surgical pathology: Gleason score 7 (3+4)
Three positive margins; Stage T2c(+)

Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 12/8/2010 11:05 AM (GMT -6)   
Once you're asleep, you have no idea who is doing what, that's the reality of surgery.

Occasionally, a surgeon will have a vested interest in doing the majority of the work himself but residents are always needed in the OR.

My wife works in an OR and has seen it all.
 
It does not mean that your op was substandard, the resident may have done more than the urology surgeon and will be up to snuff.

April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 12/8/2010 11:07 AM (GMT -6)   
I don't know if this is a possibility....

I had the robotic surgery done by an experienced surgeon done at a local (non-teaching affiliated) hospital--no resident involved. The surgeons fee was $5000. Negotiated rate the insurance company paid the lead surgeon was $2700 (the assisting surgeon got $1700).

Whether or not a resident or the experienced surgeon does the procedure, all the other expenses should be the same. I am wondering if you can get the experienced surgeon to do the whole procedure and pay out of your pocket the additional cost (should be under $3K).

If it were me, I would rather have a highly experienced open surgeon than a resident doing the robotic. Since open surgery costs less, your insurance may pay the entire amount. This same situation happened to my best friend's brother (insurance would cover entire cost of open surgery but not robotic). He had the open surgery and everything went great.

Good luck!

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean
PSA tested on 7/15/10: Zero Club membership card issued (trial membership with 90 day renewal)

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 12/8/2010 11:07 AM (GMT -6)   
No way would I ever have robotic surgery unlesss the doctor had done at least 500 procedures. This is not like having your appendix out; it is a very radical surgery in which a lot of things can go wrong and ruin your life as it now exists. Why even take the chance when surely other options exixt.
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

mr bill
Veteran Member


Date Joined Sep 2010
Total Posts : 688
   Posted 12/8/2010 1:33 PM (GMT -6)   
They should have had you sign a consent form prior to surgery and spelled everything out in black and white.  No small print.
 
Mr. Bill

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2301
   Posted 12/8/2010 2:05 PM (GMT -6)   
Every doctor in training has to learn procedures under the supervision of an experienced physician.  It's standard practice, especially in teaching hospitals.  I have no problem with that. 
 
Another urologist who had not performed a prostactetomy assisted my surgeon, who was experienced with the procedure.

klains
Regular Member


Date Joined Nov 2010
Total Posts : 79
   Posted 12/8/2010 2:47 PM (GMT -6)   
We have not done the surgery yet. We were in the "finding a good robotic sugeon", I had narrowed my search down. Called the office and was given the run around" long story. The office said the " good surgeon" works at the hospital clinic. But as explained from the nurse that called. The resident do the surgery and the experienced surgeon oversees. The thing that is puzzling me is the insurance says he is a participant doctor, but yet his office says only through the clinic. The nurse that called was from the clinic. I have put another call into the insurance company, they actually have a case worker working on this now. Either the good surgeon participates should not be listed as a provider, if he does not perform the surgery. Or if he does participate , we have hit every wall to see him. The insurance co, has been working on it the last couple of days. We really need to get this rolling. For my husband also got diagnosis with acromegaly, ( a hormone overgrowth)
Never imagined this to be a problem part. Our other option was also a teaching hospital, for open surgery, but I have to call there to see if this is also there procedure.

klains
Regular Member


Date Joined Nov 2010
Total Posts : 79
   Posted 12/8/2010 2:49 PM (GMT -6)   
if this does not work out with this doctor, still on a search for a good robotic surgeon in Connecticut.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 12/8/2010 2:54 PM (GMT -6)   

Dear Klains:

I'm glad to see that you are working with your insurance company to get this straightened out.  I know that residents must get experience somewhere but I sure didn't want one getting experience with me and was VERY CLEAR about who was involved in my procedure.  Put me down as one of the posters who recommends that you keep looking until you find an experienced doc (250+ procedures) who will do the job personally.

Tudpock (Jim)


Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

klains
Regular Member


Date Joined Nov 2010
Total Posts : 79
   Posted 12/8/2010 3:07 PM (GMT -6)   
thanks for that Jim, I was not sure if they are on my side or not. Seeing as they are the paying party. But I have a call back tommorow for a case worker from the insurance. I just put a call into the other hospital to see if this is there procedure to. I would have thought if it was common practice ( due to our insurance ) this would have been right up there when the options were originally told to us

klains
Regular Member


Date Joined Nov 2010
Total Posts : 79
   Posted 12/8/2010 3:09 PM (GMT -6)   
Dan, I was going to look into that to , if we went out of network , what the cost would be, that is a good idea. If plan A falls through. I just wish I could get a straight answer on plan A , so I can start Plan B. Already doing the homework on Plan B, just in case

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/8/2010 3:13 PM (GMT -6)   
dont you have any options beside teaching hospitals? or is that an insurance thing? I would not be comfortable with any resident in an operation that is considered one of the most complex. i had open surgery, and my uro//surgeon had nearly 30 years experience with only open surgeries, didnt have to worry about a trainee in the OR. His assistant, was the #2 surgeon in his large practice. felt i got my money's worth.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

fulltlt
Regular Member


Date Joined Nov 2010
Total Posts : 264
   Posted 12/8/2010 3:15 PM (GMT -6)   
So I take it you ruled out brachytherapy. Was that due to insurance not wanting to pay for it? My insurance paid for IMRT and brachytherapy.
age 57 2/2010
PSA 8.2 2/2010
biopsy 2/2010 - 2 of 8 left & 2 of 8 right positive, Gleason 3+4=7
attended support group - advised to get a second opinion
second opinion on pathology from John Hopkins 4+4=8
PSA 15 4/2010
5 weeks IMRT 4/2010-6/2010 at Copley Hospital in Aurora, IL
91 implants of palladium 103 7/2010 at Chicago Prostate Center, Westmont, IL
PSA 3.97 10/2010
no ED or incontinence
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