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Old 09-22-2007, 09:13 AM   #1
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Question Please help with decision.I need your input.

After much research and consultations, as well as discussions w/ my insurance company, I have narrowed down to two surgeons who are in network. I would have to travel for either surgeon but I don't want that to be a deciding factor.(although one is in Balt,Md and the other is here in Tx where I live) They both seem qualified but have very different resumes. I would be very grateful for your opinions . I have a tentative schedule w/each so I need to decide this weekend. It boils down to an excellent surgeon(Dr. Su) from a very pretigous hospital but with less actual robotic surgeries vs. a younger guy(Dr. Fagin) who has put up a crazy number of Da Vinci procedures in a short amnt. of time. I am a little concerned w/Dr. Fagin doing 4 surgeries a day @ 1-1.5 hrs. a piece. Does this mean they are cookie-cutter style vs. Dr. Su's 2 a day @ 2.5 hrs. a piece? Or does it mean Dr. Fagin is just really good and more efficient because of having done 600+ surgeries? I know there are many variables I can't control, I want to make best choice possible for my doctor. Thanks very much for your help!
Here are their bio's:
First the big gun-
Dr. Li-Ming Su -Associate Professor of Urology
Director of Laparoscopic and Robotic Urologic Surgery
James Buchanan Brady Urological Institute
Johns Hopkins Medical Institutions , BS/MD @Cornell University,Residency@Memorial Sloan Kettering
He has done 335 conventional lap procedures beginning in 2000. He will have done about 250 Da Vinci surgeries by my appt. in mid Oct. He does only 2 surgeries a day 3 days a wk. His surgery time is 2-3 hrs. He claims continence is 90% at one year. Potency is 75% at one year. He incorporates some of Dr. Walsh methods in his surgery.Is highly published and I would guess has learned from some heavies in prostate cancer, not to mention he is at the #1 hosp. in the country. He assures me he will do my entire surgery (no assistant/students at the console).


Now a guy who practices w/ a small private group called "The Urology Team" in Austin ,Texas.They purchased a robot and brought him in June,2004.
Dr. Randy Fagin attended medical school at the University of Buffalo in Buffalo, New York and joined The Urology Team from Syracuse, New York where he obtained his training in Urology. Dr. Fagin has trained with experts in Laparoscopic Urology in Paris, France, The Cleveland Clinic, New York University, Albany Medical Center, and Thomas Jefferson Hospital in Philadelphia.(I believe these were short training sessions) Dr. Fagin is currently the director of robotic surgey at St. David's Medical Center (small-ish Hosp. in Austin). He does not have the strong academic writings and bkgrnd of Dr. Su .He does seem to have impressive numbers performing daVinci robotic prostate cancer surgery. He performed 200 Da Vinci surgeries between 2004-2005. He claims to have performed 100 trad. open surgeries,300 trad lap. procedures and currently 600 Da Vinci procedures.He does 10 a wk - 4 a day Mon and Fri and 2 a day on Wed.

 
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Old 09-22-2007, 09:29 AM   #2
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Re: Please help with decision.I need your input.

Laswell,

My question would be does Dr. Su have experience with open?

I was told that at times, if a surgeon has experience with both, that is a good thing, OR, you may be left with positive margins.

If, during robotic, they run into areas of difficulty or problems they detect, they can switch to an open procedure to guarantee a successful procedure and negative margins. If the surgeon doesn't have that experience, you may be left with positive margins. That's what the surgical team at the Cleveland Clinic indicated. Just an fyi.

Anyone else hear this?

An acquaintance of ours actually had this happen to him. He went in for robotic and after a few hours, they had to switch to open.

 
Old 09-23-2007, 09:15 AM   #3
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Re: Please help with decision.I need your input.

Quote:
Originally Posted by debbie35010 View Post
Laswell,

My question would be does Dr. Su have experience with open?

I was told that at times, if a surgeon has experience with both, that is a good thing, OR, you may be left with positive margins.

If, during robotic, they run into areas of difficulty or problems they detect, they can switch to an open procedure to guarantee a successful procedure and negative margins. If the surgeon doesn't have that experience, you may be left with positive margins. That's what the surgical team at the Cleveland Clinic indicated. Just an fyi.

Anyone else hear this?

An acquaintance of ours actually had this happen to him. He went in for robotic and after a few hours, they had to switch to open.
Thanks debbie;

In my view, you are correct. My surgeon was trained on open RRP, non-robotic LRP and robotic LRP. Not only that, my primary urologist was attending during my procedure and he is certified for open RRP and non-robotic LRP. Their comments to me were the same as you indicate. At any time during my procedure, should it become necessary, they could switch to another method without any problem.
__________________
robotic LRP; Jan2007

 
Old 10-03-2007, 04:30 PM   #4
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Re: Please help with decision.I need your input.

Debbie is correct. Only a surgeon who is well qualified in the open procedure as well as having performed several hundred successful robotics should be considered. If Dr.Su (the Johns Hopkins, Sloan-Ketterring trained surgeon) meets this criteria which he most probably will its a no brainer. His stats with incontinence and impotence are also impressive as is his association with Patrick Walsh.Stay away from the Texas cowboy in his no name local hospital. This is a complicated enough surgery with only one good shot for a cure----go with the best!

Last edited by shs50; 10-03-2007 at 04:32 PM.

 
Old 10-05-2007, 05:26 AM   #5
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Re: Please help with decision.I need your input.

one size doesn't fit all, and the conventional wisdom adivce is: go with what your're comfortable with. recall that some guys prefer working for small companies or being self employed. others find very large companies a good fit. similarly, some people are more comfortable with the large surgery factories [i.e., medical centers in metropoplitan areas] but some may not be comfortable with they might see as the jiffy lube approach. the mom and pop urology shop doc can easily be as well trained and capable as those in the large centers. just as some people's consumption preferences lead them to prefer name brands while others seek generic products, individual preferences regarding how and where medical care is provided can vary. you see what i'm saying? i guess i'm saying that compent, state of the art treatment can likely be found in any envrionment that one is comfortable with. you just need to look. just as patients preferences vary, i'll be some very good docs prefer to work in mom and pop shops.

Last edited by CRS907; 10-05-2007 at 05:28 AM.

 
Old 10-05-2007, 08:38 AM   #6
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Re: Please help with decision.I need your input.

Sorry but the Jiffy Lube analogy does'nt hold in medicine and especially surgery. A surgeons expertise is heavily dependent upon his training, experience and number of specialised procedures performed. There's a reason why the best and most renknowned usually end up at the world class centers of excellance. The also rans end up at the local hospitals because they can't get the most desireable appointments at the most prestigious institutions or there's more money to be earned where profits trump best practices.
A more accurate analogy is why A-Rod and Jeter play for the Yankees and not the Toledo Mudhens. Just as in sports,and the arts, medicine has its major and minor leagues. There's reasons why royalty, celebrities and the privileged alway wind up at the Johns Hopkins, Sloan-Ketterings, Dana Farbers and MD Andersons etc. Clinton, Letterman & Larry King had their bypass at NY Prebyterian, Colin Powell,DeNiro and Scwartzkoff went to Sloan -Kettering for their prostatectomies while Joe Torre and other celebs went to Hopkins. You think these folks were getting good advice? Cancer surgery isn't about going where its convenient or where its cosier and more comfortable or staying within an insurance network. The goal is the best chance for a cure with least risk of leaving positive margins or complications. The best batting averages in these vital categories are with the most experienced superstars at the most prestigious (and demanding) institutions. You're not going for an oil change.
Bob

 
Old 10-05-2007, 11:56 AM   #7
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Re: Please help with decision.I need your input.

I'm not sure that all the best surgeons / physicians are only motivated by money as you imply by your comments. It could well be that if too concerned with results statistics, they choose who to treat. Also if they are too concerned with defensive procedures they may not give each individual the best treatment or them. They might think they are gods, but they are also human. In order to enhance their reputations they may treat celebrities better than any other joe.

 
Old 10-05-2007, 02:20 PM   #8
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Re: Please help with decision.I need your input.

Laswell,

Have you reached a decision yet? I re-read your original post and have a couple thoughts. Regarding Dr Fagin; he does an RRP in 1.5 hours? My surgery took 3.5 hours. Forty-five minutes of that was extra time spent "reconstructing the continence mechanisms." Can he do a quality job in 90 minutes? BTW, my urologist recommended Dr Fagin for a robotic RP.

Dr Su claims 90% continence in one year. The Urology Dept at Baylor College of Medicine claims 97% on their website. That statistic is the average of all of the surgeons on staff, so even the worst of them are doing better than 90%. I doubt that Baylor is cherrypicking patients. Maybe there's just some difference in the way the data is collected or organized?

Sorry to sound like such a wet blanket... Good luck with your decision.

 
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