Robotic Prostatectomy

[MStewart]

How effective are they vs. non-computer assisted? What are the best institutions that provide the robotic surgery?

Thanks in advance

---

Members don't see this ad.

 

[tugbug]

Not an expert... but I plan to stay at Holiday Inn expresses before my urology interviews... but, "effectiveness" of robot assist is similar to non-robot assists. Benefit is supposed to be in reduced recovery time/morbidity.

I would think that just about any major medical center has a robot and experienced operators these days. All of the ones I've been to have.

 

[Pir8DeacDoc]

I would think that just about any major medical center has a robot and experienced operators these days. All of the ones I've been to have.

Not entirely true. I'm not trying to be a smartass but where I am a resident (an Ivy) we only do lap prostates. I know we (the hospital) have a robot, but the main prostate guy prefers a lap prostate.

 

[tugbug]

Not entirely true. I'm not trying to be a smartass but where I am a resident (an Ivy) we only do lap prostates. I know we (the hospital) have a robot, but the main prostate guy prefers a lap prostate.

I stand corrected... not an unusual thing.

 

[Pir8DeacDoc]

I stand corrected... not an unusual thing.

I hope it didn't come out like I was being a jerk. Just giving you a heads up that it's not an automatic at all places to use the robot. From my urology buddies, I think many of them feel is sort of a gimmick the hospitals have to attract patients but doesn't really make for a better outcome.

 

[latinfridley]

I hope it didn't come out like I was being a jerk. Just giving you a heads up that it's not an automatic at all places to use the robot. From my urology buddies, I think many of them feel is sort of a gimmick the hospitals have to attract patients but doesn't really make for a better outcome.

Uro attendings Ive spoken to about this also feel that it is a gimmick to bring in
more money.

 

[CouchPotato]

I think it would be fair to say that this is a huge controversy in the field right now.

The guys who do robotics truly feel that it is superior to open. On the other hand, the data suggests the two are equivalent except the robots have a significantly shorter hospital stay and less pain (most at our hospital take nothing but tylenol or even nothing and all leave the next morning). I'm not sure there is enough evidence to compare lap to robot yet. I have found most patients make the decision themselves and then pick their urologist accordingly, and so far this year about 2/3 of prostates in this country have been done robotically.

 

[tugbug]

I hope it didn't come out like I was being a jerk. Just giving you a heads up that it's not an automatic at all places to use the robot. From my urology buddies, I think many of them feel is sort of a gimmick the hospitals have to attract patients but doesn't really make for a better outcome.

I didn't take your info in a bad way... its good to have someone correct assumptions for me when they need correcting. I hope I was clear in my "caveats". I've exactly one month each at three different urology programs (so, not much experience)... each used the robot extensively and suggested these were pretty much everywhere these days. I was working on a pretty limited bit of info.

 

[NHL Fever]

From what I've seen, the robot seems to be a gimmick to market the prostatectomy. The results appear to be no different, and its a lot more expensive. This is compared to classic open, in comparison to both lap and robot.

 

[sketches]

I am doing a 3rd year (med school) rotation with a robotic prostatectomy specialist right now and I believe that this procedure is far from a gimmick. My experience is limited, but so far I have seen ~25 robotic cases and the recovery is significantly better than the open procedure. Here, patients are walking 4-5 hours after surgery and leave the next day with an average pain rating of 1-2/10. They go home with a foley, which comes out one week later. Blood loss is typically <75cc and the procedure takes around 1.5 hours. Experience of the surgeon is obviously a key component of success with the learning curve being at lest 200 cases, so beware of judging robotic prostatectomy based on the local guys who only do a handful/year.

Although I agree that long term outcomes are similar to those with alternative surgeries, I would absolutely choose robotics if I needed my own prostate out.

 

[DrGregoryHouse]

I'm a M1 and got to play with a DaVinci a little while today. It's really really cool. Looks like something out of Star Wars. The big advantage that the DaVinci2 has over regular laproscopic surgery is that it provides stereoscopic vision so you have some depth perception. The problem with the DaVinci was that it has no tactile feedback, and he showed us he could snap a suture wire with ease. There's a genuine risk of slicing an artery.

He also said that 80% of radical prostectomies are done with the DaVinci now. Also one year after FDA approval, 20% of historectomies are done with the DaVinci. It's the wave of the future.

Did I mention it's really cool? Cause it's cool. Really cool.

 

[Pir8DeacDoc]

I am doing a 3rd year (med school) rotation with a robotic prostatectomy specialist right now and I believe that this procedure is far from a gimmick. My experience is limited, but so far I have seen ~25 robotic cases and the recovery is significantly better than the open procedure. Here, patients are walking 4-5 hours after surgery and leave the next day with an average pain rating of 1-2/10. They go home with a foley, which comes out one week later. Blood loss is typically <75cc and the procedure takes around 1.5 hours. Experience of the surgeon is obviously a key component of success with the learning curve being at lest 200 cases, so beware of judging robotic prostatectomy based on the local guys who only do a handful/year.

Although I agree that long term outcomes are similar to those with alternative surgeries, I would absolutely choose robotics if I needed my own prostate out.

In all fairness, you're personal experience and that of someone who only does them this way doesn't exactly win me over. I am a big fan of the robot but I have seen quite a few lap prostates and the outcomes were very similar to what you describe in terms of post op ambulation and pain control. Further, there are still many surgeons who advocate an open approach. If the issue were cut and dry there wouldn't be so much controversy amongst the urology community.