Open (prepubic) vs. Laparoscopic (robotic) Prostatectomy

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kingsport
New Member


Date Joined Nov 2006
Total Posts : 8
   Posted 11/24/2006 9:30 AM (GMT -7)   
I'm Tom from Kingsport.  Kat suggested I might start a new thread with my question about which surgery to opt for.  My signature has the facts about my situation.  I've been obsessing about it for a couple weeks.  Staying in town for the open surgery or traveling 5 hours (to Vanderbilit in Nashville) for the laparoscopic (robotic).  Anybody else wrestle with this kind of decision?  The research claims of the laparoscopic centers -- for the most part -- make it sound like the much-preferred surgery (regarding blood loss, pain, recovery time, & fewer urinary problems later), but other sources make it sound less clear.  I'm a bit befuddled and trying to get unstuck in my decision process. My local surgeon who does the open kind is very experienced & has a good reputation, but Vanderbilt has an outstanding rep also with the robotic-laparoscopic.  Thanks in advance for any thoughts/suggestions.  Tom

Diagnosed early Nov. '06
55 years-old
PSA 6.5 & Gleason 6 (~ 10% of right lobe)

 


josal
New Member


Date Joined Nov 2006
Total Posts : 11
   Posted 11/24/2006 12:08 PM (GMT -7)   
 Hi Tom, We traveled about 300 miles or 3 hours from Binghamton to Rochester to have robotic done. Our doctor office also set up with the hospital a reduced rate for a motel close to the hospital. I did not wrestle with my choice once I viewed my doctors video on the web and the reading I did on robotic that it was my best choice.

 54 year old robust male
 Latest PSA pre-biopsy 6.7, next PSA due 1/07
 Gleason 3 + 3
 Stage T1a
 DaVinci robotic laproscopic prostatectomy 10/11/06
 post surgery pathology:  malignancy in less than 1% of samples


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 11/24/2006 12:12 PM (GMT -7)   

I opted for the open RRP.  The reason I did was because my surgeon and hospital were less than two miles away.  In Oklahoma City there are only two Dr.s that do the DiVinci operation.  There is only one machine in the city also.  The wait time to get the surgery is about 3 months.  My Dr. made me fee very good about the open RRP.  He is assisted by one of the other Dr.'s in the practice. I have never heard if the Dr's that do the DiVinci have a assistant or not? My Dr's do so many of them they have very little blood loss.  As far as vision and magnification he said all of the structures with this surgery are large enough for im to see without the need of extra magnificaton.  Not sure how long th DiVinci operation takes but I was in and out in two hours.  I did have a 6 day stay in the hospital due to a clotting problem I had with the cathiter post op.  I have had bleeding and clotting issues with previous operations.  I don't think it had anything to do with the quality of my Dr.'s work.  It was just one of those things that happen some times.  Due to the clotting, I had to keep my cathiter for three weeks for everything to heal.  it has been two weeks since it was removed and I have no more gushing.  Only using 5 light duty pads a day.  Walking in the key to getting control of bladder back.  Was given 25mg Viagra to take daily.  Have been having some growth and firming but no full erection yet.  The incision never gave me any trouble.  Very little pain, healed up quickly

Overall, I am very pleased with my decision to go with my Dr. and the open RRP.  Being so close to the hospital and Dr. was much easier on the family.

Which ever route you take it will be the right one for you.

Good Luck


    43
    PSA 5.7 - Discovered during Annual Physical with Family Practice Dr.
    Gleason 7
    Biopsy - 3 of 12 positive (up to 75%) all on left side of prostate
    RRP on Oct, 17 - Nerves on right side saved.
    All Lab's clear.  No Cancer outside prostate
    Cathiter in for 3 weeks due to complications in healing. Removed Nov, 9
    Next Dr. Appt and first Post op PSA on Dec, 11
   


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 11/24/2006 3:28 PM (GMT -7)   
Choice of a TOP SURGEON is most important, as a very experienced surgeon will provide your best possible advantages for favorable short term, and more importantly, long term results with few side effects.
 
All other aspects, including the method used should be minor considerations.

SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 11/24/2006 5:09 PM (GMT -7)   

Tom:

I agree with Aus.  Selecting an "expert" with significant experience and exemplar credentials is the most important factor.  After my research and discussion with knowledgable professionals, I realized you go for the best out there, no matter what procedure they specialize.  If your insurance is part of a national network, don't worry about travel if you have the means to do so.  I live in Louisiana and selected a surgeon at Johns-Hopkins in Baltimore.  My insurance provided coverage at Hopkins just like it would have done if I had stayed at home.  No difference.  I did have to fly to Baltimore (not too expensive), and I booked a hotel room downtown Baltimore through Priceline (cheap) for the night before surgery and the night after discharge.  I flew back to New Orleans 72 hours after surgery (it was not difficult, really).  My "expert" specialized in the open procedure.   Here's what happened:  in hospital 48 hours; no transfusion (little blood loss for me); return to work 12 days post surgery (office job) for 2-3 hours per day the first week, 1/2 days the second, 3/4 the third, and full time the fourth; running five miles in 47 minutes seven weeks post surgery;  pad free after four weeks post catheter which I had for 10 days (I used only 28 pads the entire time); and, best of all, <0.1 PSA three months post surgery.  I never had a reason for a return visit to the surgeon. 

The point I'm making here is that the surgeon, not the procedure, should be your #1 criteria.  I think my result establishes there is little to no difference between the best open surgeon and the best robotic/lap surgeon.  If you have the means to travel to have the best surgeon, don't hesitate.  The better chance for an  excellent long-term result with an "expert" far outweighs the inconvenience/cost of travel.

That's my two cents worth.  Good luck.


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 11/25/2006 8:10 AM (GMT -7)   
I traveled about two hours to Vanderbilt to have my Da Vinci done by Dr. Joseph Smith.  This was a little over three weeks ago.  Vanderbilt's Urology Clinic does not push the Da Vinci over the open.  Dr. Smith had done over 3,000 open procedures before going exclusively to the Da Vinci and he has now done over 900 of those.  His complication rates are exceptional.  Although they have not published anything yet he told me that their internal study indicates a slightly better complication rates for incontience and impotence with the Da Vinci compared to the open.  I personally think you would be in very good hands and would find the trip rewarding.  The drive home may be a little tough because of the catheter but as long as you stop every hour and a half and walk and empty the catheter you will be fine.  I stayed one night in the hospital and one night in a local motel before heading home.  The staff at Vanderbilt are excellent especially the nurse practitioners.  If you want any more information about Vanderbilt I would be glad to talk to you.
 
Tamu
Diagnosed 7/6/06
1 of 10 core samples, 40%
Stage T1c, Gleason 3+3
Da Vinci on 11/01/06
56 Years Old
Post Op Path
Gleason 3+3
Prostate Confined


kingsport
New Member


Date Joined Nov 2006
Total Posts : 8
   Posted 11/25/2006 10:54 AM (GMT -7)   
Thanks to all of you -- Tamu, SJC, aus, kw, and josal & any others sending wise decision-making vibes. Very informative and supportive! I plan to make the decision by Monday, 11/27. ~ Tom
Diagnosed early Nov. '06
55 years-old
PSA 6.5 & Gleason 6 (~ 10% of right lobe)

 


2busymom
Regular Member


Date Joined Nov 2006
Total Posts : 118
   Posted 11/25/2006 12:49 PM (GMT -7)   
HI Tom,

I watched a video put out by Vanderbilt that showed the DaVinci being done. In it the Dr.'s explained what they thought the benefits were to the procedure. Even if you decide on the open procedure, it gives some helpful information.

becky
husband Jeff 45 years old, diagnosed 8/25/06
PSA 2.1, 2 of 12 samples at 3% & 4%, involving 1 side of prostate
Gleason 3+3=6 in both samples
laparoscopic radical prost. 10/17/06
cancer in both sides of prostate, positive in one area of margin
first PSA in 1/2007


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 11/25/2006 10:41 PM (GMT -7)   

Hi Tom *Kingsport,

 

Sending a warm welcome to you and your loved ones….

 

I personally think if someone took the time to really do a graph on open (RRP) or Lap(robotic)…. Results (blood loss, pain, recovery time, and fewer urinary problems) ~ they would be so similar. 

 

For anyone to say one is better than the other is in my opinion… not something I care to look at.   Each doctor will tell you their method is best!!! And rightfully so ~ but to say one surgery is better than the other…..   If you want open… then find the best surgeon who does RRP, if you want Lap… then find the best surgeon who does Robotics.

 

Your decision ~ is your decision ~ and it will be the right decision for you.

 

Buddy & I chose the open (RRP)  as you’ll see in “Our Journey”…. It was the right decision for us!! 

 

Our thoughts and prayers will be with you as you take the next step.  Please stay with us as you traverse the stepping-stones to be cancer free.  This journey is best traveled with friends…..

 

In New Friendship ~ Lee & Buddy

 

Sharing ~ Our Personal Threads with new members:  updated  11-17

If you or your loved ones ~  pull “1” thing from our journey that helps you on your journey…… it will truly make our hearts happy!!! 

Our Journey ~ Sharing is Caring, A Special Note for Loved Ones (Wives, Partners, & Caregivers), Give Yourself a Second Opinion, and Murphy ~ Our Special Helper.

To quickest way to find them  is to change the way you look for Threads…  I have mine set at Last Comment.  If you go in and change it to Started By and look for Bluebird (pages 4 & 5 as of Nov-10 ‘06)…. You will find them a lot easier!

 


mama bluebird - Lee & Buddy… 53 on surgery day

RRP April 3, 2006   PSA 4.6 Gleason  3+3=6  T2a   Confined to Prostate

June 29th PSA Less than 0.1 Non-detectable


JayMan56
Regular Member


Date Joined Oct 2006
Total Posts : 61
   Posted 11/27/2006 11:19 AM (GMT -7)   

Tom,

The choice is about as basic a form of individual opinion as it gets. Bottom line for me is that I need to feel comfortable with the surgeon and feel good about his experience once I've made the decision to go the surgical route. I have always been a person who embraces new things so the robotic procedure seemed the best route for me....... but that's me. I live in Miami, there are dozens of robotic machines within a relatively short drive. My insurance, while allowing me a great deal of latitude with doctors and hospitals, punishes someone going out of network. Anything done out of the state of Florida is out-of-network. The difference in out-of-of-pocket expense makes going to other parts of the country prohobitive..... not to mention I personally would not want to be isolated from family and friends while having major surgery done. In my case, one of the surgeons scheduled my procedure for early FEBRUARY! I took the date and kept hunting.

My robotic procedure is scheduled for December 12th at the University of Miami School of Medicine at Jackson Memorial. The have two DaVinci's at this hospital and my surgeon is supposed to be an ace with over a thousand procedures..... oh, and I like him as well.

Good luck in the future........

Jay


  • 56 year old male, divorced
  • Diagnosed: 10/12/06
  • Two of twelve samples contained malignent cells, Gleasons: 3+3=6, 3+4=7
  • Last PSA as of 11/5/06: 2.3
  • Scheduled a DaVinci Robotic procedure for Feb 6th
  • In control, but partially terrified about the future
  • Click (or paste) this link to watch the DaVinci Procedure: http://www.or-live.com/ShawneeMission/1664/event/webcast.cfm?


IlySara
New Member


Date Joined Oct 2006
Total Posts : 18
   Posted 11/27/2006 3:59 PM (GMT -7)   
Hi Tom,

There's not a lot i can add to what these folks have said....they all know their stuff, and it is a tough decision for you. The idea of laparoscopic appealed to me because of the recovery time from the incision alone. I'm not sure if Chattanooga is closer to you than Nashville, but if you decide on the DaVinci, you might want to check out Dr. Patrick Foley. Parkridge Hospital's nurses leave a lot to be desired, but i was only there one night. Recovery time has been awesome....i'm almost fully recovered 11 days afterward. I'm taking it slow and walking every day. I have 5 small incisions that are a nonfactor at this point. Some soreness where the drainage tube was, and soreness from the catheter, but i'm losing that fast. We wish you the best in your decision.

Blessings,

Dennis and Sara
41 years old
6.7 PSA
3+3=6 Gleason
Pre-op Stage T1c
7/12 Positive Samples in Biopsy
RLP on 11/16/2006
Cancer confined to prostate


Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 11/28/2006 7:02 AM (GMT -7)   
Tom,
I had open surgury 3 1/2 years ago when there was no other choice so I didn't have to make that decision. But as for traveling, I live in South Florida in what I think is the Urologist Capital of the world with all the senior citizens we have here. I fired 3 Uroligists because I didn't like what they were saying. With some research and after hearing that Joe Tore, Rudy Juliani, and John Kerry all had recently chose Johns Hopkins in Maryland for their surguries, I made up my mind that that was where I was going. After a extended battle with the insurance co. which the hospital helped me with, I travelled over 1,000 miles to have it done there. So I guess what I'm saying is "Go with your heart" and you will make the right decision!!
Good luck my Freind!!
Pete
53 years old, Surgury, Radical Prostatectomy 8/20/03, PSA 6.6, Gleason 3 + 3 = 6, Adenocarcinoma extent (moderate) Stage & Margin:T2NOMX, No Metastases, Organ Confined, bone scan: Neg.  


B & C
New Member


Date Joined Nov 2006
Total Posts : 13
   Posted 11/28/2006 4:50 PM (GMT -7)   
My husband, Billy, has an appointment at John Hopkins for a second opinion. When you have a consultation is it with a group of doctors or just one. Is there one doctor that anyone on this board has been to and really liked? Everything I have read and people we have talked with emphasizes how important the surgeon is but also that he needs to listen to you and you feel comfortable with him. Any suggestions?

JayMan56
Regular Member


Date Joined Oct 2006
Total Posts : 61
   Posted 12/8/2006 10:01 PM (GMT -7)   

Hi all..... Not to be a stickler about details, and not that it makes any substantial difference, but as I understand it, Rudy Giulianni did not have the surgery. He had radiation therapy in New York....... just to keep the record straight.

Jay


  • 56 year old male, divorced
  • Diagnosed: 10/12/06
  • Two of twelve samples contained malignent cells, Gleasons: 3+3=6, 3+4=7
  • Last PSA as of 11/5/06: 2.3
  • Scheduled a DaVinci Robotic procedure for Feb 6th
  • In control, but partially terrified about the future
  • Click (or paste) this link to watch the DaVinci Procedure: http://www.or-live.com/ShawneeMission/1664/event/webcast.cfm?


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 12/26/2006 5:31 PM (GMT -7)   

Hi Tom ~

 

Just checking in on you!    It’s been over a month since we’ve heard from you! tongue

Touch base when you have a few minutes.  We would like to travel with you on your journey.   yeah  

 

Buddy and I hope you’ve had a chance to visit our Thread: “Our Journey”

We chose Radical Retropubic Prostatectomy

 

Excerpt from “Our Journey”…

(C) We had already made our decision before the Consultation

Radical Retropubic Prostatectomy…..Lift the Hood …We wanted Dr. Staley to visually see and feel the tissue and take out all surrounding tissue that may be hiding… cancer cells. 

 

 

Excerpt from “Our Journey”…

KNOWLEDGE IS POWER... and POWER conquers FEAR!!!!!

We decided to share “Our Journey” in hopes of helping at least 1 person! 

If it helps more….  If it helps you!!!! That will truly be a blessing 

At no time are we writing to tell you what you must do, or what you should do….

                               Your decision is Your Decision!!

Just giving you a view of what decisions we made, what the process was for us, and the outcome as of this date. 

 

Take care and know our thoughts and prayers are with you.

In Friendship ~ Lee & Buddy


mama bluebird - Lee & Buddy… from North Carolina

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a  

Confined to Prostate   June 29th ~ PSA Less than 0.1 Non-detectable


kingsport
New Member


Date Joined Nov 2006
Total Posts : 8
   Posted 12/27/2006 6:55 AM (GMT -7)   
Thanks for the inquiry bluebird.  I've been reading routinely most of the posts here & benefiting a lot.  What a great service!  My news is that I'm scheduled for robo-laparascopic surgery at Vanderbilt -- about 5 hrs. away -- on March 7.  I'm reserving the right to change my mind before then & get the retro-pubic done locally by my much experienced urologist. It's settling to have a date of any kind, though.  Again, thanks for asking. ~ Tom

Diagnosed early Nov. '06
55 years-old
PSA 6.5 & Gleason 6 (~ 10% of right lobe)

 


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 12/27/2006 8:27 AM (GMT -7)   
Kingsport,

I see that you have scheduled a Da Vinci at Vanderbilt. I assume that Dr. Smith is who you have scheduled it with. He did my Da Vinci on November 1st. If you have any specific questions about Vanderbilt or Dr. Smith let me know. The surgical experience was excellent.

Tamu
Diagnosed 7/6/06
1 of 10 core samples, 40%
Stage T1c, Gleason 3+3
Da Vinci on 11/01/06
56 Years Old
Post Op Path
Gleason 3+3
Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 12/27/2006 9:23 PM (GMT -7)   

J Good news ~ Tom….

 

Good move in going ahead and scheduling….  It’s your decision and this gives you a window of “decision making”…

 

Your decision will be the right decision!!

 

Keep us posted okay…. we need you to touch base once in a while… You are part of our family now and we get a little anxious when we don’t here anything.  Even just a “Hi!” lets us know you’re doing okay.

 

Take care,

In Friendship ~ Lee & Buddy


mama bluebird - Lee & Buddy… from North Carolina

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a  

Confined to Prostate   June 29th ~ PSA Less than 0.1 Non-detectable

Post Edited (bluebird) : 1/2/2007 5:33:59 PM (GMT-7)


parson
Regular Member


Date Joined Dec 2006
Total Posts : 55
   Posted 1/2/2007 4:19 PM (GMT -7)   
To SJC and B & C : I have an appointment at John Hopkins in January with DR. Su . Have you or anyone used him He is suppose to be top in Robotic surgery. Barister

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 3/6/2007 8:24 PM (GMT -7)   

Kingsport signature line:

Diagnosed early Nov. '06; scheduled for da Vinci @ Vanderbilt 3/7/07

55 years-old

PSA 6.5 & Gleason 6 = 3+3(?) (~ 10% of right lobe)

 

Hi ~ Tom,

 

Just a little hug to let you know we will be there ~ in thoughts and prayers as you head into surgery…

 

Please touch base as soon as you feel up to it.

Hopefully ~ you will update us as to how your journey's gone over the past few months as you did your research and made your decision.

 

In Friendship,

 

~~~~~~~~~~~#$%^&*   Group Hug %^&*(%~~~~~~~~~~~~

From the 3 of us...

Lee, Buddy, & Murphy

 


mama bluebird - Lee & Buddy… from North Carolina

Link to our personal journey…>>>     Our Journey ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

2nd PSA 02-06-2007 Less than 0.1 Non-Detectable :)


kziz
Regular Member


Date Joined Feb 2007
Total Posts : 242
   Posted 3/7/2007 6:17 PM (GMT -7)   
Kingsport, If you had surgery today, I hope that all went very well. We too opted to travel for the robotic. We leave next tuesday and surgery a week from today. We are also traveling around the same distance, 6 hours, but have opted to fly. Good luck to you and will be watching for a reply with hopefully great news!! Courtney
Kurt & Courtney
47 year old
Great Health prior to dx
Dx on 1/29/07
PSA 4.1
Gleason 3+3=6, both lobes
Stage T2c, I believe
Tumor involves 20% of cores, both lobes
Live in OK
Da Vinci scheduled 3-15-07 in Austin


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 6/28/2007 8:51 PM (GMT -7)   

Helping to keep this journey together…..

 

(direct link ~ just click on the title!  Reminder to click on the REFRESH icon once there)

Vagaling-out during surgery

 

 

 

Surgery re-scheduled ...... see new post!


Bird6
New Member


Date Joined Jun 2007
Total Posts : 5
   Posted 7/5/2007 2:01 PM (GMT -7)   

I can not really see much advantage in Da Vinci.

I had open operation a couple of months ago and the problem post operation is urinary incontinence. This is result of damage to pelvic floor muscles and veins surrounding the prostrate.

The Da Vinci saves damage to muscles and tissue in the abdomen but it does nothing to save the pelvic floor or veins in the prosterate.

It is much more difficult for a surgeon to make a good job using Da Vinci and if there is accidental cutting of a vein it is much more difficult to control bleeding. 

Most important the surgeon can not feel any texture though the Da Vinci instruments. In my case the surgeons could feel the lymph glands and ascertain there was no trouble there, They can not do that in Da Vinci.

No doubt Da Vinci saves damage to abdomen, but this never causes a problem in open RRP; just read thes blogs and you will see no one ever has trouble with their abdomenal incision.

As said in many other blogs above your best bet is to find a surgeon who does many RRP at least two per week.

I hope all goes well

Bird6

 

 


Open RRP 29 April 07
Gleason 6
 

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