Regular laparoscopy v.s. Da Vinci Robotic ?

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WHOFAN
Regular Member


Date Joined Mar 2007
Total Posts : 24
   Posted 3/24/2007 10:59 AM (GMT -7)   
Hi,
We wanted to put a question out there to the community...

We are wondering if anyone has researched the benefits/disadvantages of the regular laparoscopy vs the Robotic? We met with a radiation oncologist who told us to really look into both (we are already leaning towards the robotic). His take was that the Da Vinci is not necessarily the "golden standard" and that the machines are so expensive that the "marketing" to promote this way as the best way overshadows all other options for surgery.
Of course we are going to meet with doctors who do both but in the meantime wondering if anyone out there had opinions on the 2 kinds of surgeries or have had the regular lap. surgery?

Thanks!
 
WHOFAN
 
Husband: 53 yrs. old
Diagnosed 3/12/07
PSA: 8.12
T Stage: T1C -  GLEASON: 7 (3+4)
Found cancer in 2 of 8 samples taken.
Currently researching doctors.  Leaning towards Da Vinci RP.
Live in Los Angeles with wife and 5 yr. old daughter.


kziz
Regular Member


Date Joined Feb 2007
Total Posts : 242
   Posted 3/24/2007 11:19 AM (GMT -7)   

WhoFan, 

We too were torn between the 2.  All the local docs here due the open.  There is one guy who just started the Da Vinci, but the others all do open.  The doc that we decided to go with locally, if we chose the open said that the only true difference was the loss of touch.  He said that if he felt a hard spot, he would cut wider. 

We then talked to a local onocologist who I knew.  He said that if it were him, he would go with the DaVinci, and Dr. F.A.G.I.N in Austin was the best in our part of the country.  He said that the only true difference was the healing time, with DaVinci winning that race. 

I watched a live prodcast of the da vinci and another that Dr. F sent us.  It was amazing.  And it talked about cutting a little wider when needed.  That, coupled with the faster healing time made up our minds.  Kurt had the Da Vinci last week, cath allready out and healing beginning.  Good luck with your decision.  Everyone has to chose their own course and believe that it is the best one for them.  This is just why we chose the way we did and NO regrets!!  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 3-14-07 in Austin
Post-Op  Gleason 6, Stage t2c nx mx  YAAAAA HOOOOOO! 


lawink
Veteran Member


Date Joined Oct 2006
Total Posts : 621
   Posted 3/24/2007 11:46 AM (GMT -7)   
I think WHO is referring to laproscopic vs DaVinci, and not open surgery at all. I've been curious as ours was referred to as laproscopic and I wondered what the difference is. Will be following this post.
;o) Linda & Bob


Bob (60) had laproscopic prostate surgery on Sept 27, 2006 - 2/12 malignant biopsy samples - gleason 3 + 3 = 6.  Follow up PSA results and pathology results received Nov 14th are NO MORE CANCER!  Gleason changed to a 3 + 4; cancer completely confined to prostate; (even a second more aggressive, previously undetected cancer)      PSA UNDETECTABLE November 2006 AND February 2007.   
 
Bob also takes Hydroxyurea to control Polycythemia (elevated red & white cells & platelets) has secondary condition . . Myelofibrosis) -- If anyone has experience or knowledge of these, please post us.

Post Edited (lawink) : 3/24/2007 1:17:11 PM (GMT-6)


WHOFAN
Regular Member


Date Joined Mar 2007
Total Posts : 24
   Posted 3/24/2007 12:05 PM (GMT -7)   
Yes Linda & Bob,

We are not even considering "open surgery"....Just regular laproscopic which is done by human hands or the robotic da vinci. Both are less invasive than open surgery; but which is really the better one?? Like we said in our first post, we were all about the "da vinci" but the radiation oncologist now urged us to consider both da vinci and the "human" laparosopy route. Again he claimed that one is not necessarily better than the other. Gosh, do these decisions ever end? It's mind-boggling!

Bob had the regular laproscopic? Sounds like he did well.... the recovery is probably just as good as the da vinci.

Thanks.....
WHOFAN (Cynthia & David)
 
WHOFAN
 
Husband: 53 yrs. old
Diagnosed 3/12/07
PSA: 8.12
T Stage: T1C -  GLEASON: 7 (3+4)
Found cancer in 2 of 8 samples taken.
Currently researching doctors.  Leaning towards Da Vinci RP.
Live in Los Angeles with wife and 5 yr. old daughter.


lawink
Veteran Member


Date Joined Oct 2006
Total Posts : 621
   Posted 3/24/2007 12:16 PM (GMT -7)   
Hi Cynthia & David - yes Bob did extremely well with the regular laproscopic. His first urologist pushed for open surgery (as that's what he does) but Bob's brother had had the laproscopic just 1.5 years prior, so we asked to be referred to his doctor and have been more than pleased. He had 5 entry points (same as DaVinci); had a drain tube until he went home; looked like he'd been shot; but today, has marks that are almost unnoticeable, except of course for the main entry one which has reshaped his belly button. . . . . <<grin>>

Good luck in your decision. Down the road (before you know it) this will be a distant memory and the cancer will be GONE!!

;o) Linda & Bob
Bob (60) had laproscopic prostate surgery on Sept 27, 2006 - 2/12 malignant biopsy samples - gleason 3 + 3 = 6.  Follow up PSA results and pathology results received Nov 14th are NO MORE CANCER!  Gleason changed to a 3 + 4; cancer completely confined to prostate; (even a second more aggressive, previously undetected cancer)      PSA UNDETECTABLE November 2006 AND February 2007.   
 
Bob also takes Hydroxyurea to control Polycythemia (elevated red & white cells & platelets) has secondary condition . . Myelofibrosis) -- If anyone has experience or knowledge of these, please post us.


kziz
Regular Member


Date Joined Feb 2007
Total Posts : 242
   Posted 3/24/2007 1:08 PM (GMT -7)   
Sorry about the mis post. What we have been told told regarding lap vs the da vinci is that the robot's precision is greater. We didn't really research much after that. My grandfathers best friend had the lap 5 years ago and is doing great. My grandfather called me in the beginning to tell me to tell kurt that his friend could still have an orgasim. Not something I ever wanted to hear my grandfather say, but...... haha. Good luck in your search for answers. 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 3-14-07 in Austin
Post-Op  Gleason 6, Stage t2c nx mx  YAAAAA HOOOOOO! 


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 3/24/2007 1:11 PM (GMT -7)   
My research has assured me that the DaVinci robotic Laproscopic surgery is far superior to the non robotic labroscopic surgery.  The reason usually given is that it is more precise and the doctor has a clearer vision of the procedure. A skilled surgeon doing the more traditional "open surgery" can do a great job as well, but the healing is longer and the potential for complications is greater.
 
We know from reading here, that all of these have been used with great success.  I have had no significant healing problems from my DaVinci procedure. Don't be pressured by us or a doctor into one type over another.  Make your decision carefully and then commit to it.
 
Good Luck
 
Biopsy 10/16/06
T2A,  PSA 4.7
Gleason 4+4=8 right side
adrenocarcinoma of prostate
DaVinci Surgery 01/16/07
Post op report,confirms Gleason4+4=8
no extra extension/invasion identified
age 65
golf game bad, but active
 
 


Joes411
Regular Member


Date Joined Mar 2007
Total Posts : 87
   Posted 3/24/2007 3:37 PM (GMT -7)   
Hi Cynthia,

I have read that traditional laparoscopic surgery is more difficult to master and the hand movements are counterintuitive (ie.. turn right to go left). With Robotic the magnification of the surgical field is much greater and the range of motion for the surgeons hand movements are greater.

I pasted a link on your earlier thread to an interview with Dr Kawachi. He is also an expert with traditional laproscopic surgery and he describes the differences between the two.

Cheers,
Joe

Age: 51

PSA  Jun06  4.1  (PSA Jun05  1.2)

1st Biopsy Nov06 – Atypical cells but no cancer

2nd Biopsy Jan07 – 1 of 16 cores positive

Stage T1c   Gleason  3+3=6

 


WHOFAN
Regular Member


Date Joined Mar 2007
Total Posts : 24
   Posted 3/25/2007 7:22 AM (GMT -7)   
Thanks Joe and lifeguyd....
We have an appt. this coming Weds. with Da Vinci surgeon Robert Reiter at UCLA...
We'll take it from there...thanks again...

Cynthia & David
 
WHOFAN
 
Husband: 53 yrs. old
Diagnosed 3/12/07
PSA: 8.12
T Stage: T1C -  GLEASON: 7 (3+4)
Found cancer in 2 of 8 samples taken.
Currently researching doctors.  Leaning towards Da Vinci RP.
Live in Los Angeles with wife and 5 yr. old daughter.


SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 3/25/2007 8:47 AM (GMT -7)   

To Cynthia and David:

I learned after extensive research that if you opt for surgery, your next #1 decision should be the surgeon, not the type of procedure.  You want to make sure that your surgeon has extensive experience (which means a good patient track record for success) and exemplar credentials (he's smart).  There are experts at lap surgery, Rob/lap surgery and open surgery.  I could not find a single surgeon who was an expert at more than one.  Therefore, when you go to a urologic surgeon, he will tout only whatever procedure falls within his expertise.

Not all surgeons are experts (in other words, not all have extensive experience and exemplar credentials).  I suggest you make your decision primarily on the fact that your chosen one meets the high standards of excellence I set when making my selection this past June.

For example, my chosen one was based at Hopkins and had performed more than two thousand "open" prostatectomies over the past 15 plus years.  He had an excellent track record and is reknowned in the academic field.  My surgery took one hour, I was hospitalized 48 hours, I did not need a transfusion because I lost little blood, I used only 28 pads total (one per day for four weeks when I went pad free), I returned to work part time 12 days post surgery (office job) and full time four weeks post surgery, recommenced my running exercise program six weeks post surgery and was up to seven miles at the seven week mark with no stamina or continent problems (9:30 mile pace).  Age 50 at time of surgery.  <0.1 PSA three months post-surgery.  I give credit for the success of surgery and speed of recovery to God and my surgeon's ability.

The point I'm making here for you is the type of procedure should not be your #1 concern.  There are urologic surgeons who are "experts" as I have described and there are those who are not at that level of skill and brilliance.  You should set as your #1 criteria the selection of nothing short of an "expert" to perform whatever procedure he specializes.  That's how you get the result I got a few months ago.


StrictlyInc
Regular Member


Date Joined Dec 2006
Total Posts : 353
   Posted 3/25/2007 10:34 AM (GMT -7)   
Da Vinci allows for greater magnification and precision than laparoscopic, which is why I chose the former.

Also, I'd suggest going with the surgeon you feel best about. That surgeon will have their own preferred method.

I used Dr. Reiter @ UCLA, and if need be, he will fall back on an open surgery (if there is a malfunction with the robot, for example).
____________________
 
Prostate cancer diagnosed:  May 15, 2006 (age 40)
Gleason score:  3+3=6
daVinci radical prostatectomy:  July 25, 2006
size of tumor:  approx 1.1 inches
post-surgery Gleason score:  3+4=7; negative margins from surgery
number of pads/day at 3 months after surgery:  3 to 5
number of pads/day at 4 months after surgery:  1 to 2
number of pads/day at 6 months after surgery:  0 to 1
1st post-surgery PSA:  0 (Nov 2006)
2nd post-surgery PSA:  0 (Feb 2007)
ongoing post-surgery treatment:  Cialis every other day, Viagra "on-demand", ErecAid pump daily Cialis every other day, ErecAid pump twice daily (when I can manage it)
 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 3/25/2007 10:56 AM (GMT -7)   
whofan
 
i elected radiation treatment but did extensive research and considertion on surgery before deciding on my treatment.  if i had elected surgery, it would have been robotic.  one article i read indicated that mastery of lathroscopic prostate surgery (before robotic surgery became available) is very difficult and for the doctor performing the surgery it is like performing the surgery looking in a rear view mirror.  in today's world, either have the open radical surgery or robotic.
 
dave
68, Biopsy 9/27/06, Stage T1c, PSA 7.1, Gleason 6 [less than 5% in two areas], Gleason 7 (3+4) [less than 20% in third area], negative DRE, bone scan and MRI. Starting proton radiation therapy 2/22/07.


cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 7/31/2007 5:29 PM (GMT -7)   
I too am in a quandry over type of surgery. I have appointments with the best that I have found in both Robotic and Laproscopic procedures. I am wondering who in 2006/2007 that had surgery opted for laproscopic vs. robotic and why. I have read about both pros and cons of both. Every time I think I have this issue figured out, I have more questions. Starting to think maybe I should just go with open with the best open surgeon I can find. Help.

wamba2000
Regular Member


Date Joined Jul 2007
Total Posts : 25
   Posted 8/1/2007 11:01 AM (GMT -7)   

Cynthia, my best to you whatever decision you both make.

I agree with SJC, once you decide to have surgery, the surgeon is the most important decision.  In my case, my surgeon had done over 1000 "open" RRP's and admitted that he did not have experience with laparoscopic procedures, talked about the "touch" advantage that he felt open surgeries allow, but also would refer out if I insisted on a LRP.  I was able to check the State Medical Examiner website prior to making my original appointment to make sure there was no history of complaints, lawsuits or malpractice.  I also spoke with two of the doctor's patients/families that had been through the procedure.  With this I made my decision to proceed, and I am pleased with the results so far.

My prayers are with you for guidance, strength and knowing that whatever decision you two make, that you will have success.


Age: 56
PSA: 4.1 (first test) 4.2 (second test)
Gleason: 6, cancer found in both sections of prostate
Surgery: Open RP on 5/1/07
Pathology: All contined with the gland, no spread
Catheter out: 5/15/07
Incontinence: at 10 weeks to one pad per day
ED: slowly getting better
First Post-Surgery PSA: set for 8/6/07
 
 
Spread the word to men you know or meet: See your doctor. Have a PSA test early.


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 8/1/2007 3:50 PM (GMT -7)   
Hi. I agree with wamba 2000 in the fact you need to check out your doctor. They are only human and make mistakes and have problems just like the rest of us. You need to make sure they have no professional or criminal problems. Being an investigator for most of my 33 year law enforcement career, you would be suprized what you might find out. Just like most of the advise you have already have from the great people at this site, investigate all your options, make a decision and don't look back. Good luck and God bless you.

Mika-mvesr

JuRon9
Regular Member


Date Joined Aug 2007
Total Posts : 22
   Posted 8/3/2007 12:38 PM (GMT -7)   
I wouldn't recommend LRP. It's past technology. Robotic will replace it completely in the future. Cost is the only reason we still have LRP. Medical centers won't be in any hurry to replace LRP because of their investment. It is very difficult for surgeons to master LRP. I know some have had successful LRP procedures but not everyone will be blessed to have the best surgeons. My surgeon lied to me on the phone when I asked him how many he had done and he told me about 240. The night before the surgery he told me he had only done 50. Maybe I was one of those rare cases but I was under for 10 1/2 hrs. He told me that my surgery was his most difficult. Surgery was about 8 hrs. Lost 5 pints of blood. Being under anesthesia for very long has long term negative consequences on your body.
Ron
62 W/M healthy DX PCA 6/1/2003 PSA 6.3 Gleason (3+4)=7, T1c. LRP 7/1/2003-Path. T2b All Clear, prostate 62 grams. 4 years still <.10. Now 66yrs. old


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 8/3/2007 2:49 PM (GMT -7)   

 

juron9

I'm sorry to hear that you had problems with lap surgery.  I agree completly with you.  No one should consider lap surgery unless it is DaVinci Robotic. I would rather have open surgery 10 times than have one inexperienced (or maybe even an experienced)  doctor try lap surgery without the DaVinci guidance.

Doctors are people.  We are people.  We mess up sometimes and don't like to admit it.  Doctors mess up sometimes and ....

We have all learned so much here and other places.  While talking to a friend who is also a recent PCa graduate, I made a few statements regarding how urologist should look at and treat prostate cancer. He said, "Oh yeh, we can tell our docs some guy on the internet said it so you should consider it"

Maybe some of them should.


 
Biopsy 10/16/06
T2A,  PSA 4.7
Gleason 4+4=8 right side
adrenocarcinoma of prostate
DaVinci Surgery 01/16/07
Post op report,confirms Gleason4+4=8
no extra extension/invasion identified
age 65
Back on the golf course...
90 day PSA  less than 0.01 (undetectable)
 
 

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