Thanks for the list, Kemahsabe.

DaVinci robotic has not been my therapy, but I got an interesting perspective on it at our last Us Too support and education group meeting.

We had a panel of three speakers - a medical oncologist, a radiation oncologist, and a urologist - give us a review of recent developments in their fields. The senior urologist is prominent locally and has been one of our sponsors for about a dozen years. In fact he was the surgeon for several of our regular participants.

He said he is at the point in his career when he chooses not to learn the new robotic techniques, but refers patients to a colleague in his practice for robotic. What struck me was when he stated that he now does only a handful of radical prostatectomies a year, instead referring almost all patients to his colleague for robotic.

He is one more doctor I have heard of many who said he is impressed with the lower apparent level of complications and side effects, as well as more rapid recovery, from robotic surgery. We have had several patients say the same thing about their experiences with robotic, though one patient had a complication and was not as pleased as the others.

I have heard only one doctor call attention to some negative consequences of robotic. He was a prominent urologist formerly known for his RP work who had switched to cryosurgery and who had become a cryo advocate. He pointed out that there were quite a few cases where robotic surgery had caused some serious complications. That led me to recall a conference presentation I had heard on robotic, and between the lines the expert robotic specialist who was presenting hinted at the same thing. He did that when he briefly talked about the learning period for robotic, stressing that a surgeon needed to do a few hundred procedures before he was really proficient, and noting that slip-ups could be bad for the patient.

I think the take-away lesson is that robotic surgery looks like an excellent option at this point, but that you don't want to let a robotic surgeon operate on you who can't demonstrate that he has performed enough procedures.

Jim

Hi Jim:
Glad to add to your new thread on robotic prostatectomy. Recently had my annual follow-up in Dr. Scardino's office at Sloan-Kettering and made a few inquiries as my most recent 3 friends whom I referred to Dr. Scardino he in turn referred to his colleague and recruit from France,Dr.Bertrand Guillenneau. He recruited Dr. Guillenneau about 4 years ago to head his growing minimally invasive prostate surgery dept. Dr. Guillenneau who as you know pioneered the robotic RPP in Paris and trained the first robotic surgeons who brought the technique over here. Dr. Scardino now is the head of all surgery at Sloan-Kettering.
Dr. Scardino is performing fewer and fewer open surgeries because he's convinced that the current outcomes from robotics when performed by top robotic surgeons are as good as from open surgeries with shorter stays and quicker recoveries. He was quick to point out and also mentioned in his book, Dr. Scardino's Prostate Book, that robotic prostatectomy has a much shorter learning curve than the traditional open procedure and it therefore attracts more young surgeons who never mastered the open procedure.The caveat is that if the robotic surgeon has to revert to the open procedure due to unforseen complications such as invasion to surrounding tissues or structures, he may not have sufficient experience to do the best job and may leave positive margins behind. He mentions a situation where the robotic surgeon was forced to revert and due to his inexperience with open prostatectomies struggled for many hours to remove the prostate causing excessive blood loss and other complications. He stressed that that the best robotic surgeons are also highly experienced with the open procedure and can perform it satisfactorily when necessary.
You may also be interested to know that a robotic expert at Weill-Cornel NY Presbyterian Hospital has recently developed an improved technique for sparing both nerves and preserving erectile function woth the robotic procedure. I've forgotten his name but the technique is very new and only available there at the present but was reported on in one of the urology journals.
Happy New Year Jim.
Bob

My experience...
I asked my urologist (not my surgeon) about the popularity of robotic LRP in my region. He told me that, since most hospital groups in the area have invested heavily in the da Vinci system, there's quite a bit of pressure on urology practices in the region to get up to speed on this procedure. He said, "Not every prostate cancer patient qualifies for this procedure." However, he went on to say that when the da Vinci surgery is appropriate and when a patient is given the choice, most patients are opting for the da Vinci robotic procedure over the other surgery choices. I'm sure he can only speak for our specific region. He further explained that when the choice is da Vinci surgery, most urology practices must subcontract with the few experienced da Vinci surgeons from the big city teaching hospitals and universities to perform and proctor this procedure. Hence, to avoid being left behind with regard to the latest technology and procedures, most urology practices in my area offer the da Vinci procedure by proxy. This was my experience. Basically, as I understand it, my surgeon (Columbia University MC) was asked by my urologist to visit our region and perform my procedure. My procedure was observed and recorded by several local urologists for training purposes. My urologist is currently in training on the da Vinci system and when he gets certified and is considered proficient, his urology practice will offer the robotic procedure in-house and will not need to subcontract this work.

Excellant post Able 5. What you describe seems to be happening elsewhere as well. However, though your procedure was undoubtdely performed by an experienced expert in the procedure there are many surgeons who as you point out are gearing up or already doing it right after certification. I'm not sure of the required number of procedures required for certification but I'd be surprised if its over 50.
One of my close friends was recently referred by his urologist to a De Vinci Robotic certified surgeon who had done over 50 procedures but located close to where the friend lived. We(myself and another friend who were Sloan-Kettering alumni) convinced him to see Dr.Guillonneau at Sloan who has performed thousands and helped develop the method. Why go to a 90 day wonder if there are real real experts available and accessable?
Certainly the newbies need patients to gain expertise but not with my friends or family.

I must agree bob...

My gut feeling (not fact) is that for every guy doing extensive research about eminent surgeons or having close friends or relatives to point to such surgeons in the field of prostate cancer, there are 100 other prostate cancer patients who are like sheep going to slaughter. No access to internet, not a clue where to go or what to do, they are at the mercy of the first urologist/surgeon they happen to find in the Yellow Pages. Again, that's not documented, that's just the impression I get talking to other prostate cancer patients who happen to be friends, people at work, at church, at the gym, etc. If my gut feeling is even close, I believe that the 90 day wonder has no problem getting their share of patients.

Well put! :)

I was extremely fortunate that my first urologist was so unsuitable that I swiftly learned this key lesson. Despite my PSA of 113.6, the doctor who had reluctantly ordered the test, at my insistence, referred me to a friend of his who had had some bad luck and he was trying to help the guy out. It turned out that "my" urologist's associate, from whom he rented office space, had lost his license due to malpractice, and the fallout was a decreased patient load for "my" doctor. Reacting like so many of us, for the first two weeks I had complete faith in "my" doctor, until shortcomings became evident. I soon learned he was not even a board certified urologist. :( I never returned to him after the biopsy.

Jim

I have some startling news to report on robotic surgery for prostate cancer.
I was in the office of Dr.Bertrand Guillonneau at Sloan-Kettering today, supporting a friend I refered to him who wanted robotic surgery.
Dr. Guillonneau who is quite charming and soft spoken told us, that while he would perform the surgery for my friend, he wanted us to know he has given up the use of the De Vinci Robot and gone back to straight laparoscopic prostate surgery. When I asked why, he said after all the robotic surgeries he's performed he has concluded that the robotic offers no advantages to the patient and he believes he can do better work with his own hands laparoscopically.He said the robotic has its advantages for the less experienced surgeon because its easier and quicker to learn but he personally will no longer be using it. I then asked him if he was familiar with the work and nerve sparing technique being used by Dr. Tewari. He said "Certainly, I trained him." No further comment.
I thought this was extraordinary coming from the worlds greatest expert on the robotic technique.
Bob

C'mon now... Let's be reasonable about this. The fact that Dr. Guillonneau trained Dr Tewari (presumably in laparoscopic surgery) doesn't mean that Dr Tewari didn't develop a new technique after he completed training. Otherwise, Einstein's high school math teacher could logically claim credit for the Theory of Relativity because he 'trained' him.

No one implied that Dr.Tewari didn't develop some new wrinkle in robotic nerve sparing. Certainly Dr. Guillonneau didn't when he answered he was familiar with Tewari's work and he had trained him. Lets not read anything in to his anwer.
Also, I'm not in a good position to anwer Able 5's question on how a surgeon gets better tactile feel without the robot never having performed the procedure myself. He merely said he does better work without it and it offers no advantage to the patient.
From slides I've seen of the robotic and non-robotic laparscopic surgery, the surgeon holds and uses the instruments with his own hands in the non-robotic and presumeably has a better visual field than with the older open prostatectomy since there is much less bleeding. With the robotic, the surgeon sits across the room and performs the surgery remotely by manipulating the robot's controls. I guess this removes the surgeon further from directly manipulating the instruments and with less feel than when he's doing it himself.

No one implied that Dr.Tewari didn't develop some new wrinkle in robotic nerve sparing. Certainly Dr. Guillonneau didn't when he answered he was familiar with Tewari's work and he had trained him. Lets not read anything in to his anwer.
Also, I'm not in a good position to anwer Able 5's question on how a surgeon gets better tactile feel without the robot never having performed the procedure himself. He merely said he does better work without it and it offers no advantage to the patient.
From slides I've seen of the robotic and non-robotic laparscopic surgery, the surgeon holds and uses the instruments with his own hands in the non-robotic and presumeably has a better visual field than with the older open prostatectomy since there is much less bleeding. With the robotic, the surgeon sits across the room and performs the surgery remotely by manipulating the robot's controls. I guess this removes the surgeon further from directly manipulating the instruments and with less feel than when he's doing it himself.

Here I go again--double posting. Sorry.

An update to my earier post which reported that Dr. Guillonneau had told a friend he had given up use of the robotic and returned to straight laparoscopic prostatectomies.
I referred another friend who decided to have a robotic RP to both Dr.Tewari and Dr.Guillonneau so as to have perspectives from these two top surgeons and the opportunity to choose the Dr. who gave him the most confidence. He just called to tell me he consulted with Dr.Tewari last Tuesday and Dr. Guillonneau yesterday and decided to go with Guillonneau. When I asked what led him to choose Guillonneau he said he felt while Tewari was probably at the top of his game with the robotic RP, Guillonneau was the more experienced and gave him a better feeling. It was a choice between the young star and the older master.
When he asked Guillonneau about why he had given up the robot and returned to the laparscopic he gave the same answer as to my other friend. The robot offered no advantage to the patient and he went on to say that the instruments he used laparoscopically were superior and more sensitive than those attached to the robot. He could do more delicate and effective surgery without the robot.
Thought you'd all be interested in these off the cuff comments by the leading laparoscopic and robotic prostate surgeon in the world and chief of minimally invasive prostate surgery at Sloan-Kettering. My first friend will be operated on Feb.20 and today's reporter in early April after a 5 week vacation in St.Maarten. I'll report on the results of each.
Bob

i'll bet a lot of docs, patients, and in general men of science bristle and wonder at your dubbing one of these guys the unequivocal " . . . leading . . . laproscopic . . . robotic surgeon . . . in the world." that's quite an assertion.

Among the "men of science" of my acquaintence, principally physicians and surgeons at major teaching hospitals in the NY metro area, one of whom is my nephew, such as Weill-Cornell NY Presbyterian Hospital ,Columbia-Presbyterian and Memorial SLoan- Kettering Cancer Center and Hospital for Special Surgery , men of the stature of Peter Scardino, Chief of surgery at MSKCC, and Patrick Walsh of Johns Hopkins fame refer to Dr. Guillonneau as the world's leading laproscopic prostate surgeon.
The reputations of world class physicians and surgeons are generally created by their peers and those whom they've trained who are most familiar with their work and publications. Their are good reasons why Craig Smith stands out and has a world wide reputation as the leading open heart surgeon at Columbia Presbyterian, Jeff Milsom as the leading colo-rectal surgeon at Weill Cornell, Valerie Rusch the leading thoracic lung cancer surgeon at MSKCC, etc. While there's no official directory of the worlds leading physicians and surgeons to my knowledge, the best tend to be at the best and leading institutions of the world and their peers are aware of and admire them for their vast skills and experience. They also share their skills, experience and techniques with those whom they help train and who in turn add to their reputations.
Also when presidents, world leaders, celebrities and other VIPS are reported in the media as having been treated by these same "leading" specialists their reputations are further enhanced.

Also as far as "men of science bristling----" is concerned I forgot to mention that our own primary care physicians here in NJ are usually the first to recommend and have made appointments for us with these top specialists in NY when we've needed serious treatment, consultations or surgery. To be fair there are those "men of science" here who are offended when we take our more serious problems "across the river" and aren't willing to use the associates they recommend "who are as good as any in NY". This is a common problem faced by suburban physicians and surgeons in close proximity to NY and other major metropolitan areas. Some of the Dr's on the staff of the large urban hospital in Newark on whose board I served for several years were very sensitive about losing patients to NY institutions and Dr's. It became a business problem as well which we attempted to solve by forming an affilliation with one of NY's top hospitals. Under the affilliation their leading specialists would visit our hospital on a weekly schedule and see patients here. However the surgeries were performed in NY and the arrangement served well for both hospitals but the principal beneficiaries were the patients who received the highest standard of care.

My husband had robotic surgery at Henry Ford Hospital in Detroit four years ago. He had a PSA of 4.0. He had an over night stay, and then came home. The cancer is still not detected after four years, and he is doing very well. His PSA is 0.01 now. I believe the robotic surgery saved his life, and would recommend it to anyone.

My husband had robotic surgery at Henry Ford Hospital in Detroit four years ago. He had a PSA of 4.0. He had an over night stay, and then came home. The cancer is still not detected after four years, and he is doing very well. His PSA is 0.01 now. I believe the robotic surgery saved his life, and would recommend it to anyone.

Congratulations! It's posts like this that are great encouragement for newbies to this disease. Prostate surgery, prior to the 1990's, was brutal! Very bloody and the side effects were often life long. Today, prostate surgery is a much more exact science. The tools are more precise and the techniques are more advanced. The side effects, in many localized cases, clear up in time. Thanks for your post!:)

COUPLE OF QUESTIONS: How old is he? How is he doing with incontinence and ED issues? :confused: