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Open v Robotic Prostatectomy etc.

User
Posted 26 October 2017 13:56:45(UTC)

This is not an in depth report and I would advise any man considering a Prostatectomy to do his research and discuss with his consultant.

I have posted this because some men are under the impression that robotic is 'best' and are disappointed if not offered it by their treating hospital.  It does have some advantages which include shorter recovery time , sometimes less blood loss and less scarring but is not best suited for some men.  Some surgeons prefer open where they have better access and more feel and the operation takes less time.  Read on how some surgeons are reverting to open being less satisfied with robotic results. http://www.dailymail.co.uk/sciencetech/article-5014679/ROBOTS-no-better-performing-surgery-humans.html

 

Barry
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User
Posted 26 October 2017 13:56:45(UTC)

This is not an in depth report and I would advise any man considering a Prostatectomy to do his research and discuss with his consultant.

I have posted this because some men are under the impression that robotic is 'best' and are disappointed if not offered it by their treating hospital.  It does have some advantages which include shorter recovery time , sometimes less blood loss and less scarring but is not best suited for some men.  Some surgeons prefer open where they have better access and more feel and the operation takes less time.  Read on how some surgeons are reverting to open being less satisfied with robotic results. http://www.dailymail.co.uk/sciencetech/article-5014679/ROBOTS-no-better-performing-surgery-humans.html

 

Barry
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User
Posted 26 October 2017 15:21:53(UTC)

Nicely balanced Barry

We can't control the winds - but we can adjust our sails
User
Posted 26 October 2017 15:30:35(UTC)

Hooray!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 26 October 2017 18:31:39(UTC)

Interesting Barry.

I did try to find the research that supported the NHS decision to invest so much in robotics but didn't get to the source.

The surgeon we consulted with prefers open surgery.

Thank you for sharing Barry

User
Posted 26 October 2017 19:57:06(UTC)

Hi Barry

I was more than happy to have open surgery, you can’t beat a good grope around. And who wants to be suspended upside down. The cost of these robots is unbelievable.

Stu

User
Posted 27 October 2017 16:20:20(UTC)

When a top Urologist, quoted in the article, speaks for open surgery, I believe him, especially as I went to the man to get a second opinion on an op to deal with what I then believed to be a single met (or residue left over from a radical cystectomy - it was never clear which). He was very impressive and honest. In my days of working, we had a simple management principle - KISS - keep it simple, stupid. It seems urologists are starting to see the merits of that, too!

AC

User
Posted 27 October 2017 22:08:24(UTC)

Interesting article Barry.

I could have insisted on robot surgery but knew it was going to take another referral to another hospital so was keen to go ahead with non-robot believing the experience of the surgeon was a known and likely to be as good as robotic.

Medically the article doesn't change the order of preferences, i.e. robot, non-robot, open.  It says the difference between robot and non-robot isn't big and asks if the cost is justified.  It also says that some surgeons prefer open.   

No doubt some cases are better with open and in a sample of surgeons you'd be almost certain to find some who prefer open even though it's a riskier and more costly operation in terms of bed time.

Also prostate surgery wasn't part of the trials listed in the article and so we're reading into it the same applies.  In the newspaper I read the Leeds surgeon says robots shouldn't be introduced 'as a free for all' but they should be continued as they will give advantages in more complex surgery in time.

User
Posted 27 October 2017 22:23:21(UTC)

Good points Pete but the lead surgeon in Leeds told John 7 years ago that he would get better results with open RP than in LRP and there was a UK data set published 2 years ago showing that robotic increased the risk of positive margins, ED and incontinence so this latest news simply supports what the data has been indicating for a while.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 31 October 2017 16:03:39(UTC)

I'm a newby so please bear with me - if I read your comment correctly Lyn you're a pro "open RP" ?

User
Posted 31 October 2017 19:17:54(UTC)

Very much so, Jeff but each man should follow the advice of his surgeon. My frustration is that men chase the robotic surgery assuming it is best but it only takes a quick look at members here to see that the men with very poor outcomes tend to have had keyhole / robotic RP.

NHS data supports that as well - it is a tough choice isn't it - less blood loss, shorter hospital stay, hopefully back at work quicker (but more risk of poor outcomes) or more risk in theatre, longer time off work but less risk of long term side effects.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 31 October 2017 20:28:24(UTC)
We have not been offered Open or Laparoscopic. Leicester seem to prefer Robotic. I would like to think they do offer them when appropriate. I suppose once they have invested around 2 million they need to use it. There is always a slight risk they might have to convert to open if either Laparoscopic or Robotic goes wrong so I hope future surgeons will still have the skills to do open when needed.

A very interesting video to look at on YouTube is Masterclass 2010: Robotic Prostatectomy: Better or not?

Although slightly dated they discuss the pros and cons.Sadly the consultant Mr J Anderson leading the discussion has since died from advanced prostate cancer.
 
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