Robotic Surgery

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Herophilus
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Date Joined Sep 2009
Total Posts : 657
   Posted 3/9/2011 12:15 PM (GMT -6)   

This may be old news but I thought it was interesting.

The following surgical procedures are being done by robotic surgery (primary robotic surgery or robotic assisted surgery) at the hospital system that did my robotic prostate surgery;

General Gynecological Surgeries, Gynecological Cancer Surgeries, Urologic Surgeries, Partial Kidney Resection, ( I spoke with a young surgeon that has taught this kidney surgery in several countries. It is a method to remove a cancerous growth from the kidney and preserve the kidney function.) Head and Neck Surgery, Whipple Procedure for Pancreatic Cancer, Colorectal procedures for cancer and non-cancerous conditions, Thoracic surgeries, including a full lung lobectomy to treat lung cancer, Pelvic Floor Repair, and Esophageal/Gastric surgery.

Admittedly it is my understanding that the full lung lobectomy was investigative. I am not attempting to debate open / robotic approach in surgery. I’m acutely aware that individual patient conditions may actually require open surgery. I was just impressed that robotic technology has been adapted to such diverse surgical specialities. These surgical cases were done using the da vinci robotic surgical system.

Hero


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3624
   Posted 3/9/2011 10:00 PM (GMT -6)   
There is a growing blowback that seems to point to better results being obtained with open surgery for PC at least..Perhaps the skill level of the growing pool of robotic surgeons is not keeping up with the demand and the high skills of the older surgeons who perform the open procedure is making itself known...JMHO
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Sleepless09
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Date Joined Jul 2009
Total Posts : 1267
   Posted 3/9/2011 11:19 PM (GMT -6)   
Hi Fairwind, that's interesting. Where does the blowback info come from?

I'd heard the opposite. I only have anecdotal evidence, (a conversation with a doctor in a casual setting, not formal visit) who, when he found out I'd had my PCa surgery by da Vinci said that he'd seen several articles lately which were starting to show better surgical outcomes with da Vinci, rather than open. I didn't ask where, or exactly what, he'd been reading, as once you've been carved up it matters not. The dye is cast.

However, it didn't surprise me as I figured the experience of the robotic surgeons was going up while the older open guys were slipping over the hill.

My father-in-law was an anesthetist and from dinner table talk I learned to fear any old guy surgeon --- at least when I was 18 these slipping over the hill surgeons seemed like old guys. From my current vantage point 50 years later, I'd see them as younger men in the prime of life!

Back then the problem with the older guys was that they didn't seem to be aware of what their time was compared to younger surgeons, that they didn't seem to be aware of how their outcomes compared to younger hands, and they were resistant to learning new ways --- their way was the best way. My father-in-law retired 30 years ago, so that's the story from one hospital from a long time ago. Nevertheless, I have a couple of doctor friends who, when they, or their family, are in need of surgery, always seem to seek out the younger hands. Again, anecdotal.

While my dye is cast and it matters not what the stats say --- I could be anywhere on the bell curve and only time will tell where --- I'd still be interested to know where your 'growing blowback' is coming from, Fairwind. Thanks. P.S. I've always loved your healingwell name: Fairwind.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 3/9/2011 11:44 PM (GMT -6)   
This was discussed in a thread a week or two ago:

jama.ama-assn.org/content/302/14/1557

This is a population based study, that is, it looks at a randomly chose portion of a whole population getting treated, in this case, Medicare patients from 2003 to 2007. It is affected by the fact that the treatments are not randomly chosen, and it includes all procedures regardless of the skill and experience of the surgeon. It doesn't show what happens under the best possible circumstances, but it is a snapshot of what is happening out in the real world. It is funded by a Dept of Defense training grant, so that should not be a source of bias. It's published in a major medical journal.

This seems like a good study that raises concerns that in everyday practice, around the US, robotic surgery during the years 2003-07 led to a higher percentage of ED and incontinence complications.[url]

Post Edited (Postop) : 3/9/2011 10:48:53 PM (GMT-7)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/10/2011 5:32 AM (GMT -6)   
All I can add to this thread is what our urologist/surgeon told us three years ago. He has been practicing for over 20 years and has done both open and robotic surgery for prostate cancer. His preference is robotic because, in his opinion, the camera gives him the ability to view the entire area (front, back, sides) before making a cut. In my husband's case, one of the positive cores from the biopsy was very close to the edge of the prostate. Before cutting, he spent quite a bit of time using the camera to closely inspect the prostate especially in this suspicious area. He decided to be over cautious and cut a wider than necessary margin around this part of the prostate to ensure that nothing was left behind.

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3731
   Posted 3/10/2011 5:42 AM (GMT -6)   
Sheldon,
I have seen studies with results both ways now. Some say robotic is better and some say it is worse for incontinence. about 1 1/2 years ago I did an admittedly unscientific, informal poll here with about 50-80 responses (I don't remember exact number). The results matched the published results indicating higher incontinence rates with open surgery at 3 months and at 1 year.
I don't have time to look it up now - maybe later.

There is one conclusion we all can agree on. The daVinci can perform a 'currencectomy' from our wallets more completely than open surgery.
Jeff
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Gleas 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 3/10/2011 8:05 AM (GMT -6)   
it all depends on the skill of the surgeon.

From what I was told by everyone while investigating is that in the right hands, robotic is better for incontinence, ED, recovery, blood loss, margins. That was certainly my case.

The learnign curve for robotic can be 200-400 according to some. According to a surgeon I had spoken to that had 400 under his belt the learning curve is 200.

Before 2010, the vast majority of robotic surgeons had performed under 400. Some still... that means they were essentially in training while operating on patients.

I also wouldn't want open surgery performed by an inexperienced surgeon.

This si also very much old school versus new school. Robotic is taking over in terms of volume and the old school is clearly resentful. People seem to prefer the robotic approach at this point. I did. What is critical is to pick an experienced surgeon.

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 3/10/2011 8:23 AM (GMT -6)   
Thanks all for the information, most interesting, although as I noted, after having chosen which way to go, only of academic interest. Too late to go back and change now, no matter what the stats say.

Hero --- good to see your name, and hear from you. I trust all goes well.

On your point about the things da Vinci is used for, I was aware as I rolled into the operating room that the beast at the end of the table also did hysterectomies and as I lay there I was thinking I'd checked out the surgeon, the hospital, the anesthetist, as best I could but not the critical issue of "who loads the softwear?"

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/10/2011 9:28 AM (GMT -6)   
davidg said...


Before 2010, the vast majority of robotic surgeons had performed under 400. Some still... that means they were essentially in training while operating on patients.



Where do you get those figures from?

TrekRef
New Member


Date Joined Jan 2010
Total Posts : 8
   Posted 3/13/2011 8:11 PM (GMT -6)   
For what it's worth: "The surgeons needed to perform more than 1,600 operations before they were able to gauge with at least 90 percent accuracy how much tissue surrounding the tumor they needed to remove to get all the malignant cells."

http://www.bloomberg.com/news/2011-02-16/doctors-need-1-600-robot-aided-prostate-surgeries-for-skills-study-finds.html
Age at diagnosis: 53, PSA 7.7 (3.5 after e.coli was treated)
Biopsy 14/1.5 14 cores, 1 positive 1 "suspicious"
Gleason 3+3=6
open RRP at Johns Hopkins 11/07/09 Catheter Out 11/16/09
Pathology: Lymph nodes & Seminal vesicles neg.
Margins neg.
10 wks: always dry at night but 2 pads/day
11 wks: one pad day
16 wks: no pads
1 yr: slight leakage with heavy exercise

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 3/13/2011 10:56 PM (GMT -6)   
that's one of the reasons I picked a guy with 3000 surgeries
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