Open or Robotic Prostatectomy

[Lost_Sheep]

Open or Robotic?

A new wrinkle has cropped up in my journey towards prostatectomy. I have a penile implant whose reservoir is right next to my prostate.

My surgeon (who I am reliably told is the best prostatectomy surgeon in the area, Dr L) told me that there is a risk of damaging the reservoir when removing the prostate. So, if he begins the surgery, he might see danger, so would abort the prostatectomy before removing anything. An open prostatectomy might give the surgeon a better view of the surgical field.

Does anyone have any wisdom to lend me so I can make a choice between open or robotic prostatectomy?

My choices are 1) Dr L, robotically 2) open prostatectomy with Dr S (the surgeon who did the implant) 3) open prostatectomy with Dr L. or 4) fly to Seattle's Fred Hutchinson University of Washington to have robotic surgery with a surgeon who likely has encountered this situation before (but this would likely delay surgery another month). Or 5) a choice I have not considered?

Thanks in advance

[Currumpaw]

Lost_Sheep,

My thoughts--not to be taken as gospel, there is much less blood with robotic than open. Visually, an experienced surgeon using robotic should have quite an edge over open surgery---should. Just my opinion from many hours of reading. There are no guarantees. Even the very best at what they do have failures.

"Likely encountered"? Not good enough! Get all the info you can before making a decision.

My best to you,

Currumpaw

[Murk in reply to Currumpaw]

Currumpaw could be right. I have no facts but always lean towards the best experts so if the Seattle's Fred Hutchinson University of Washington Surgeon is top notched and has experience, I would at least call'em ASAP for opinion and feedback and even see what their schedule is like. You will at least learn some more etc and maybe even another option??

[dentaltwin]

Wouldn't the surgeon be the one to ask as to whether one is less risky in your particular situation than another?

FWIW, my younger brother had an open RP 10-15 years ago. I had a laparoscopic RP 5 years ago today. So far, both of us are doing well.

What I have read about robotic surgery is that it is "non-inferior" to non-robotic surgery. I have seen very little that shows a clear superiority (for robotic surgery in general, not specifically for RP). What I HAVE seen consistently is that there is a steep learning curve with the robot, and you want someone with a lot of cases under their belt. That probably isn't an issue with your surgeon. My perhaps cynical sense is that robotic surgery is mostly a great promotional tool; patients hear about it, they ask for it, and surgeons are happy to comply.

[Lost_Sheep]

Currumpaw, yes blood loss is less likely with robotic than with open. But I believe, at least in my case, the open surgery gives the surgeon a better view of the operation and ability to manipulate the reservoir to keep it out of harm's way.

Murk, Currumpaw, calling Fred Hutchinson is problematic. The Veteran's Administration is footing the bilil and I would need to get switch authorizations from Dr L to Fred Hutch to make such a call. I am seeking a workaround to get that done, though.

Dentaltwin, yes the surgeon is the one to ask, so that is what I did. As I understand what Dr L said, the outcomes of each are about equal, but the robotic is not as facile as the open at keeping the reservoir undamaged and preventing infection if there is a problem with it. As far as the robotic gaining favor for the "gee whiz" factor (and profit margin perhaps), I discount that. The robotic is definitely easier for the patient to recover from, leaves smaller scar and has less chance of blood loss.

Thanks for your thoughts, guys.

[FMOH_N]

Both alternatives are acceptable as long as the surgeon is expert in his field. The most important issue is the outcome. Wishing you the best of health.

[groundhogy]

have you explored radiation options?